Cognitive processing therapy for sexual assault victims.

Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.     

Vaginocervical cytology in victims of sexual assault

To investigate the role of vaginocervical smears in alleged victims of rape, we reviewed the findings in 4,220 consecutive rape victims between the years 1982 and 1989. These rape victims showed a slight increase in cellular abnormalities (1.18% vs. .93%) when compared to a group of 17,187 routine smears from an indigent population in 1989. While the differences in the spectrum of cellular abnormalities were not statistically significant, the increase in abnormal smears is remarkable because of the younger age distribution and lower risk factors for cervical cancer in this group of rape victims (41% of the victims were never seen at our institution before their evaluation for alleged rape and were most probably of higher socioeconomic status and at lower risk for cervical cancer than the indigent population served at our hospital). This finding may reflect the low incidence of vaginocervical cytology screening among the general population of which rape victims are a random sample. Fifty-seven percent of the rape victims with cellular abnormalities who were also regular patients at our hospital returned for follow-up by appropriate repeat smears or biopsies. This was lower than the 95% general follow-up rate of vaginocervical smear abnormalities among the rest of the population screened at our hospital. We detected spermatozoa in 56% of the smears from victims who were examined within three days of the alleged sexual assault. Cytology adds to the criminal investigation of rape cases as we detected spermatozoa in four of 16 semen-negative cases from a random sample of 53 cases evaluated by the state crime lab.     

Medical and social aspects of sexual assault of males: a survey of 100 victims.

Sexual assault of males is an infrequently reported and a poorly understood phenomenon. Details of 100 victims who sought assistance from a nationwide agency set up specifically to provide help for such individuals are reported here. Twenty eight victims were aged 16 years or over at the time of assault. The assailants were known by 72 of the victims and were perceived by the victim to have a heterosexual orientation in 72% of these cases. Attacks were often multiple and in 33 cases involved disruption of skin or mucous membranes. Twenty victims received threats about the possibility of transmission of the human immunodeficiency virus and 17 victims sought medical advice following the assault, most commonly from their general practitioner. It is suggested that greater opportunities for medical and psychological support should be given to male victims of sexual assault.     

The effects of sexual assault on men: a survey of 22 victims

Twenty-two men, who had been forcibly sexually assaulted, participated in a study to determine the circumstances of the attacks and the effects on the victims. The immediate and long-term responses were very similar to those described in female victims of rape.     

Predicting post-traumatic stress disorder: validation of the Trauma Screening Questionnaire in victims of assault

BACKGROUND: No accurate means of determining which individuals will develop post-traumatic stress disorder (PTSD) following a traumatic event has yet been identified. This study aimed to determine the validity of the Trauma Screening Questionnaire (TSQ) in predicting the development of PTSD following assault. METHOD: Five hundred and sixty-two individuals who presented to an emergency unit following assault completed the TSQ between 1 and 3 weeks later. The Davidson Trauma Scale (DTS) was completed by the same individuals at 1 month and 6 months following assault to determine the presence of PTSD. The predictive power of the TSQ was determined by statistical tests. RESULTS: The TSQ was an effective means of predicting future PTSD, with a sensitivity of 0.85, specificity 0.89, negative predictive value (NPV) 0.98 and efficiency 0.90. The positive predictive value (PPV) was lower (0.48), probably as a result of the relatively low prevalence of PTSD at 1 month (11%) and 6 months (8%) following the assault. CONCLUSIONS: This study suggests that the TSQ can be used between 1 and 3 weeks after assault to help identify individuals who will develop PTSD.     

Who do young adult victims of physical assault talk to about their experiences?

Many victims of physical assaults do not report the assault to the police. In this study we examine whom these victims talked to and how satisfied they were with the help they received. A sample of 374 participants of the Dunedin Multidisciplinary Health and Development Study (DMHDS) who had been assaulted in the preceding 12 months, were asked questions about an assault that had the greatest impact on their life and who they had talked to about it. It was found that not only did very few participants report the assault to the police; most victims talked to no one. If they did talk to someone, they were more likely to talk to friends and family and find them more helpful than the police and other services. Talking to others appears to be influenced by the nature of the assault, as participants were most likely to report serious assaults resulting in injuries requiring medical attention. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 479–488, 2004.     

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims

Ninety-six female assault victims with chronic posttraumatic stress disorder (PTSD) were randomly assigned to 4 treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Treatment consisted of 9 twice-weekly, individual sessions. Independent evaluations were conducted at pretreatment; posttreatment; and 3-, 6-, and 12-month follow-ups. All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other, and these gains were maintained throughout the follow-up period. However, in the intent-to-treat sample, PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity, depression, and anxiety. SIT and PE-SIT did not differ significantly from each other on any outcome measure.     

Diffuse axonal injury caused by assault.

The case reports of 50 fatal head injuries caused by assault and managed at the Institute of Neurological Sciences, Glasgow, were reviewed. Fifteen cases had diffuse axonal injury. Diffuse axonal injury is a well recognised type of brain damage brought about by a head injury, usually as a result of a road traffic accident or fall from a height. It does not seem to be widely appreciated that it may also occur as a result of an assault. This has important medicolegal implications.     

Acute management of the sexual assault victim.

Sexual assault victims usually seek emergency medical care at urban hospitals. The incidence of over 52,000 cases a year reported by the FBI does not include instances in which the victim died, cases of statutory rape (victim below the age of consent), or cases not confirmed by the police. It is well known that sexual assault is one of the most unreported crimes. The incidence of this crime in affluent communities is unknown. Rape occurs in any community but nonhospital professional services may be more easily available in some.     

Depressive symptoms in rape victims. A revisit

Ninety recent victims of sexual assault were assessed within 4 weeks of the assault for evidence of depressive symptomatology and major depressive disorder. The results suggested 43% of the subjects met Research Diagnostic Criteria for major depressive disorder, with sleep disturbance and dysphoria being the most frequently endorsed symptoms. Older subjects and subjects who had been sexually victimized prior to the current assault were at significantly higher risk for developing major depressive disorder post-assault. Follow-up assessments revealed a diminution of depressive symptoms by 3 months after initial assessment and a continuing stabilization of mood at 6 and 12 months.     

Secular trends in psychiatric diagnoses of suicide victims.

Post-mortem psychiatric diagnoses are compared in two cohorts of male suicides from St. Louis (1956-1957) (Robins, 1981) and San Diego (1981-1982) (Rich et al., 1986). Similar structured interviews and diagnostic criteria had been used in both assessments. Substance/alcohol abuse has remained the major diagnosis in suicides under age 60. Rates of depressive disorder alone have decreased overall, due mostly to decreased rates in the elderly. Thus, depression occurs more frequently in younger ages. Comorbid depression and substance/alcohol abuse has also increased in younger ages. Implications in terms of the so-called 'cohort effect' are discussed.     

Posttraumatic stress symptoms in victims of childhood incest.

The relationship between posttraumatic stress disorder (PTSD) and the experience of severe childhood incest was investigated in a comparison of 97 adult female victims of incest and 65 matched controls. It appeared that 62% of the incest victims and none of the controls met the DSM-III-R criteria for PTSD. The best predictor for the development of PTSD appeared to be the subjective reaction at the time of the event, consisting of anxiety, freezing and dissociation. The incest victims also displayed other psychiatric symptoms, such as self-mutilation and conversions. Although the relation incest-PTSD is quite obvious, the diagnosis may easily be missed because the symptoms may be masked by other psychiatric phenomena.     

The pupillometric response as a parameter of self-esteem.

Investigated the relationship between self-esteem and the pupillometric response. Because a positive correlation has been established between pupillary dilation and positive interest in an observed stimulus, it was hypothesized that self-esteem would be correlated positively with the pupillometric response when Ss (N = 82) viewed photographs of themselves. Results indicated that self-esteem was related to the pupillometric response only for females. The relationship, however, was opposite to that predicted. The greater the pupillometric index, the poorer the self-esteem. It is suggested that in a situation in which implicit anxiety states are involved, sympathetic nervous system activity predominates over the interest value of the stimulus. It may be that females more than males are constitutionally prone to exhibit this sympathetic reaction and/or are more responsive to the body image properties inherent in the stimulus photographs.     

Positive and negative life changes following sexual assault.

A longitudinal study was conducted to investigate (a) the timing and course of posttraumatic growth and (b) the relations between positive and negative life changes and posttraumatic distress among recent female sexual assault survivors (N = 171). Most survivors reported positive change even at 2 weeks postassault. Positive changes generally increased over time and negative changes decreased, although change in different domains followed different courses and there was significant individual variability in change patterns. Both positive and negative changes were associated with distress in expected ways, although the relations with negative changes were stronger. The least distress at 12 months was reported by those who noted positive life changes at both 2 weeks and 12 months postassault. Implications for theory and research on posttraumatic growth are discussed.     

Assessment of self-esteem in mid-aged women

Objective

To assess self-esteem and affecting factors in a middle-aged Ecuadorian female population using the Rosenberg Self-Esteem Scale (RSES).

Study design

This was a cross-sectional study in which 149 women (40–59 years) were requested to fill out the RSES and a general socio-demographic form containing personal and partner data.

Results

Mean age of sample was 47.6 ± 5.5 years, a 67.8% had less than 12 years of schooling and 33.6% were postmenopausal. At the moment of the survey 2.7% were on hormone therapy, and 2% were taking psychotropic drugs. Mean total RSES score was 26.6 ± 3.1 (median 26, range 17–35). A 35.6% and 18.1% of women respectively presented total RSES scores below 26 (median) and 25 (25th percentile) suggesting lower self-esteem. Total scores did not differ when comparing older age, menopausal phases or time since the menopause. Logistic regression analysis determined that women with lower parity and an unhealthy partner were related to lower total RSES scores (below the 25th percentile) suggesting lower self-esteem.

Conclusions

In this mid-aged series lower self-esteem was not related to the aging process per se yet to socio-demographic female/male aspects. More research is needed in this regard that incorporates other sociological aspects.