Survivors’ Advice to Service Providers: How to Best Serve Survivors of Sexual Assault

Recognizing the relatively low rate at which sexual assault survivors seek services, researchers in the last decade have turned their attention to better understanding survivors’ experiences with victim services. Surprisingly, limited research has directly asked sexual assault survivors for recommendations on how to improve victim services, including both criminal justice and community-based services. The current study builds on the existing literature to gather input from women survivors that can translate into ways to improve victim services. As part of a larger longitudinal study, the current investigation asked 224 ethnically diverse adult (aged 18–62) women survivors of recent sexual assault to provide recommendations for how victim services can best serve survivors of sexual assault at multiple time points. Nearly all women in the study (91%) offered specific recommendations on how to improve victim services. Recommendations included ensuring availability of a female provider, improving communication with survivors as well as within and between service providers, helping survivors obtain resources, believing and not blaming survivors, demonstrating greater understanding of trauma-related responses and approaching survivors with greater compassion, and implementing better training on effectively working with survivors. Implications for victim service provision are discussed.     

Autobiographical Memory Disturbances in Childhood Abuse Survivors

Summary

Clinicians have noted that childhood abuse survivors frequently report that they have forgotten large parts of their childhood. While memory for abusive experiences has attracted a great deal of attention from researchers, other types of memory disturbances may also accompany a history of childhood trauma. Many clinicians report that certain types of sexual abuse, and abuse at certain developmental stages, is more likely to result in reports of gaps in memory for the abuse. However, because information has been mainly collected in clinical populations, the possibility of confounding between abusive experiences and psychological disturbances cannot be ruled out. This article reports on data gathered from a large, epidemiologic study conducted within a health maintenance organization. A history of childhood physical or sexual abuse doubled the prevalence of general autobiographical memory loss for women, while for men, the rate increased 1.5 times over those with no abuse history. Higher rates of autobiographical memory loss were noted where both types of abuse were reported. Further, multiple incidents of sexual abuse, sexual abuse by a relative, and more severe sexual abuse increased reports of autobiographical memory loss. Theoretical perspectives on changes in the memory system that may affect trauma survivors are discussed.     

Sexual Abuse Prevention for Individuals with Mental Retardation: Considerations for Genetic Counselors

It is now widely recognized that children, adolescents, and adults with mental retardation are especially vulnerable to sexual abuse. Because at least 10% of genetic conditions are reported to include mental retardation as a feature, the provision of services to individuals with mental retardation represents a substantial portion of the case load for many genetic counselors. Our objective is to educate genetic counselors and other health professionals about this vulnerable population in order to enhance the frequency and efficacy of inquiry into sexual education and sexual abuse prevention training for patients with mental retardation. The following review article is intended to assist genetic counselors by increasing their knowledge of factors that lead to sexual abuse and provides recommendations for integrating this information into the counseling interaction.     

The case against the routine provision of psychotherapy to children/adolescents labeled “sexually abused”

Whether symptomatic or asymptomatic, children labeled sexually abused are routinely offered treatment at considerable financial cost. One result of this is that mental health professionals are being charged with exploiting the problem of child sexual abuse (CSA). Is the routine provision of psychotherapy for children and adolescents labeled sexually abused warranted? In this paper, it is argued that the evidence indicates it is not warranted. Further, its provision is not in the best interests of either the children or mental health professionals. A number of recommendations are given which follow from the evidence.     

Evidence Supporting an Independent Association between Childhood Physical Abuse and Lifetime Suicidal Ideation

A regionally representative Canadian sample was used to investigate the gender-specific relationship between childhood physical abuse and lifetime suicidal ideation. The prevalence of suicidal ideation was about five times higher in abused men and women compared with their nonabused counterparts. After controlling for five clusters of potentially confounding factors (adverse childhood conditions, socioeconomic factors, health behaviors, psychosocial stressors/chronic illnesses, and mental health), childhood physical abuse was significantly associated with suicidal ideation (OR(adjusted) women = 4.48, 95% CI = 3.32-6.04; men = 3.57, 95% CI = 2.08-6.14). These findings suggest childhood physical abuse is independently associated with suicidal ideation and highlight the importance of providing preventative treatment to childhood abuse survivors.     

Developing Black Mental Health Provision: Challenging Inequalities in Partnership

This article describes and comments upon the process of developing the Sanctuary project in London, a project that will provide two community-based crisis support services for African and African-Caribbean women and men in mental crisis and distress. This initiative is informed by the extensive research documenting the ways in which mainstream, mental health services fail Black people, and by evidence suggesting that innovations in service provision for Black people are often vulnerable and limited in their impact. In an effort to avoid replicating these problems, considerable emphasis has been given to developing the project in partnership with the main stakeholders—in this instance statutory and Black voluntary sector agencies as well as Black users, carers and community members. Within this context, issues relating to inequalities can be proactively addressed, thereby reducing the risk that they undermine the effectiveness of service provision at a later stage. However, working in partnership can also hinder or delay service developments if discussions between stakeholders become protracted or conflicts unresolved. The author draws on experience gained from this project to identify the potential as well as the difficulties of using a partnership approach to developing effective Black mental health provision. The author's role in the development of these projects has been as representative of one of the partners, the King's Fund Centre for Development.     

African American and White Women’s Experience of Sexual Assault and Services for Sexual Assault

This article presents the results of a study assessing the needs and experiences of African American and White female survivors of sexual assault in the state of Maryland. Eight specific hypotheses regarding differences in the needs and experiences of African American as compared to White women receiving partial or no support through analyses of interview data drawn from 213 survivors (African American survivors, n = 133; White survivors, n = 80) were explored. No differences were reported in medical care received; however, in comparison to their White counterparts, African American women reported decreased use of sexual assault crisis centers and mental health services, and postassault help-seeking through use of sexual assault hotlines. Barriers and facilitators associated with treatment experiences differed by ethnicity. Findings are discussed in relation to future directions for research, and service and policy improvement for survivors of sexual assault.     

DISORDERED EATING AND PERCEPTIONS OF CHILDHOOD ABUSE AMONG WOMEN IN A PRIMARY CARE SETTING

Research has demonstrated links between sexual abuse and disordered eating among women in college student and mental health samples. Little is known about such relationships among women from other samples or the relationship between other forms of childhood abuse as well as disordered eating (vomiting, starvation, laxative abuse). Prevalence of disordered eating was significantly higher among women who indicated a perceived childhood history of sexual, physical, or emotional abuse or who had personally witnessed violence.     

Sexual assault history and use of health and mental health services

A history of sexual assault may be associated with increased current use of mental health and medical services because of the psychologically and physically disruptive consequences of assault. To test this hypothesis, we estimated rates of mental health and medical services use among 2560 randomly selected community residents, 343 of whom had been sexually assaulted. Sexual assault was associated with seeking both forms of care. Controls for demographic variables, psychiatric diagnosis, health status, and insurance suggested that assault increases use indirectly, through poor mental and physical health. Uninsured, assaulted respondents were especially likely to consult medical providers. Respondents assaulted during childhood were particularly likely to seek mental health care. Assault was more common among mental health service users than nonusers, and among women using medical services compared to female nonpatients. The high prevalence of assault among service users underscores the need for providers to recognize and treat sexual assault-related problems.     

The Influence of Religion on Victims of Childhood Sexual Abuse

Survey responses of 5,417 women were studied to obtain information about childhood sexual abuse, religion, and mental health. There were 653 (13%) who reported being sexually abused while growing up. When studying those who were sexually abused, it was found that this childhood experience was associated with less emotional maturity, lower self-esteem, more instability in their relationships with partners, and higher levels of depression. The highest scores on the mental health indicators were found for women who were not abused and highly religious, then highly religious and abused, and the lower scores for no abuse and low religiosity, low religiosity and abuse, and medium religiosity and abuse. These findings were interpreted as demon- strating that religion could help ameliorate negative mental health outcomes associ- ated with childhood sexual abuse.     

Unresolved Childhood Sexual Abuse: Are Older Adults Affected?

This article presents case studies and discussions regarding three observed characteristics of unresolved childhood sexual abuse in adult survivors over 65 years of age. Specifically, chronic depression, elder abuse, and the misdiagnoses of residual abuse trauma as dementia or mental illness are compared to parallel issues identified by researchers in younger adult survivors. A brief overview of the childhood abuse literature and recommendations regarding professional training, the development of new services, and additional research are included.     

Retrieval inhibition of trauma-related words in women reporting repressed or recovered memories of childhood sexual abuse

Several authors have argued that survivors of childhood sexual abuse (CSA) who report to have repressed their traumatic memories are more skilled in forgetting emotional stimuli than survivors who have always remembered the abuse. The current experiment employed a list-wise directed forgetting task to investigate whether women reporting repressed (n = 16) or recovered (n = 23) memories of CSA are better at forgetting disturbing material, relative to women reporting having always remembered their abuse (n = 55) or reporting no history of abuse (n = 20). We found no support for the hypothesis that women reporting repressed or recovered memories of CSA are especially versed in inhibiting retrieval of trauma-related words. Additional analyses revealed that participants characterized by a repressive coping style did not display a superior retrieval inhibition mechanism for negative material.     

Testing Posttraumatic Stress as a Mediator of Childhood Trauma and Adult Intimate Partner Violence Victimization

This study examined whether potential posttraumatic stress disorder (PTSD) mediated the relationships between different forms of childhood trauma (sexual abuse, physical abuse, violence between caregivers) and intimate partner violence (IPV) victimization (psychological, physical, sexual). Participants were 1,150 female nurses and nursing personnel. Path analytic findings revealed potential PTSD partially mediated the relationships between childhood sexual abuse and psychological IPV and childhood sexual abuse and sexual IPV. Potential PTSD did not mediate the relationship between other types of childhood trauma and IPV. This study adds to the literature indicating PTSD as a risk factor for revictimization in the form of adult IPV among women. Screening for and treatment of PTSD among female child sexual abuse survivors could prevent future IPV victimization.     

Further Labeling Within the Category of Disability Due to Chemical Dependency Disorder

This paper raises issues of validity and consequences of appending the label Borderline Personality Disorder to chemically dependent women who are adult survivors of child sexual abuse. Parallels between documented sequelae of childhood sexual abuse and DSM-III-R delineated characteristics of Borderline Personality Disorder are noted as is the DSM-III-R insertion of "No information" with respect to Predisposing factors. This clinician suggests that the label Borderline Personality Disorder and its accompanying assumptions function to generate negative expectations regarding both the course and direction of the therapy process. By failing to consider the impact of childhood abuse this label provides neither appropriate diagnosis nor therapeutic directionfor women with a diagnosis of chemical dependency who are adult survivors of childhood sexual abuse.     

Mental health service use by African American women: exploration of subpopulation differences

Studies focusing on mental health service use have consistently viewed African American women as a homogeneous population, and very few studies have examined subgroup differences. However, important differences exist both within and between groups in lifestyle, stressors, type and availability of support resources, societal interactions, and risk-taking behaviors. This study examined rates and patterns of mental health service use by African American lesbian women and a matched sample of heterosexual women. Results suggest both similarities and differences in factors associated with use of services. Despite evidence of substantial emotional distress, relatively few African American lesbian and heterosexual women reported current use of mental health services. These findings are consistent with past reports on African American heterosexual women but differ from other published reports on lesbians' use of therapy. Findings from this study, including clear differences between lesbians and heterosexual women in past use of therapy and preferences for mental health providers, have important implications for service provision.     

Recovery from sexual assault: an innovative two-stage group therapy model

This article describes an innovative two-stage model of sexual assault therapy groups for women in a university setting. This model is recommended for use in various settings and includes a supportive therapy group and two specialized therapy groups, one for childhood sexual abuse survivors and the other for sexual assault (acquaintance rape and stranger rape) survivors. Theoretical underpinnings of the model are discussed in addition to practical aspects of group development such as elements of an effective group, screening of potential members, and marketing and recruitment techniques.     

The Role of Sexual Trauma in the Treatment of Chemically Dependent Women: Addressing the Relapse Issue

A review of the literature indicates a high incidence of sexual trauma among women who seek treatment for substance abuse. Additionally, clients who have experienced sexual trauma appear to be more susceptible to relapse, the return to substance abuse. This article explores issues surrounding sexual trauma and chemical dependency. It aims to provide direction for relapse prevention with a relapse-prone population. Application of traditional milieu substance abuse treatment for sexual trauma survivors is explored. Recommendations for working with sexual trauma survivors who are also substance abusers are presented, as are suggestions for research.     

Sexual Assault History and Health-Related Outcomes in a National Sample of Women

This study examined correlates of past-year chronic medical conditions and lifetime contact with health care professionals for mental health and substance abuse problems in women with differing histories of sexual victimization  ( N  = 627)  identified from the National Comorbidity Survey (e.g., assault in childhood, adulthood, or both life phases). Posttraumatic stress disorder (PTSD) and stressful life events were associated with greater odds of chronic medical conditions among women sexually assaulted in childhood only. Additional traumatic events were associated with greater odds of chronic medical conditions among victims of adult sexual assault. Older age and being married were associated with greater odds of lifetime health care professional contact for mental health/substance abuse issues among certain victim subgroups. Stressful life events were related to greater help-seeking for child victims, and traumatic events were related to greater help-seeking in adult victims. Alcohol dependence symptoms and PTSD were each associated with greater odds of lifetime health care professional contact among women victimized in both life phases, whereas depression was related to greater odds of help-seeking for women victimized in one life phase only. Psychosocial factors may play unique roles in health outcomes for women with different sexual assault histories.