Sexual assault of men in the community

Sexual assault of men in the community, a hidden and unacknowledged crime, has recently become the subject of medical and psychological literature. The present research, conducted in 1992, was designed to determine the nature and existence of this crime in the United States through victim reports to agencies servicing the needs of sexual assault victims. Out of the 336 surveys returned, one hundred and seventy two agencies reported contact with 3,635 men who had sought treatment for sexual assault occurring in their adulthood. Most assaults occurred between the ages of 16 and 30 in which the vast majority of these men experienced symptoms of Posttraumatic Stress Disorder. The presentation of these figures should alert health professionals to the existence of adult male rape and inspire further research to assess this hidden form of sexual victimization. © 1997 John Wiley & Sons, Inc.     

Emergency evaluation and intervention with female victims of rape and other violence

Given the high prevalence of crime within the general population and the increased rates of victimization among those seeking medical care, professionals who work in emergency departments, primary care medical facilities, or mental health settings need to be prepared to address physical and psychological problems related to sexual and physical assault. In this paper, interpersonal violence prevalence studies are reviewed in terms of study design and findings for sexual assault and physical assault. Common injuries following both forms of assault are documented, followed by a review of long-term medical outcomes. In addition to a review of physical health outcomes, primary psychological effects of violence are also reviewed. Strategies with which to screen for interpersonal violence in the medical setting are offered, and issues related to mandatory reporting are summarized. Interventions for assault victims that can be implemented in the medical setting are outlined, and a new hospital-based treatment for victims of rape is described.     

How to Right a Wrong: Empirically Evaluating Whether Victim,Offender, and Assault Characteristics can Inform Rape Kit Testing Policies

ABSTRACT

Hundreds of thousands of previously untested sexual assault kits (SAKs) have been uncovered in police property storage facilities across the United States, representing a national failure in institutional response to sexual assault. Faced with this discovery, jurisdictions must now decide if and how they should test these kits. Some stakeholders have suggested prioritizing kits for testing by victim, offender, or assault characteristics, based on the belief that these characteristics can predict the likely utility of DNA testing. However, little research has examined the empirical merits of such prioritization. To address this gap in the literature and inform SAK testing policies, we randomly sampled 900 previously untested SAKs from Detroit, MI. The sampled SAKs were submitted for DNA testing, and eligible DNA profiles were entered into Combined DNA Index System (CODIS), the federal DNA database. Police records associated with each SAK were coded for victim, offender, and assault characteristics, and logistic regression analyses were conducted to test whether these characteristics predict which SAKs yield DNA profiles that match (“hit”) to other criminal offenses in CODIS. Testing this sample of previously-untested SAKs produced a substantial number of CODIS hits, but few of the tested variables were significant predictors of CODIS hit rate. These findings suggest that testing all previously-unsubmitted kits may generate information that is useful to the criminal justice system, while also potentially addressing the institutional betrayal victims experienced when their kits were ignored.     

Sexual abuse of children: A review of the empirical findings

This paper reviews empirical findings of the past decade concerning the incidence and effects of child sexual abuse. First, incidence studies which consider intrafamilial and extrafamilial abuse victims of both sexes are reviewed. Research findings on short- and longterm consequences to female incest victims are then reported. Risk factors are identified for the child, the perpetrator, and the nonoffending caretaker. Theoretical literature is discussed to a limited extent throughout. To date, few empirical studies have utilized large sample sizes, adequate comparison groups, objective measures, and statistical data analysis. More well-designed research is needed so that fuller explanatory models of child sexual abuse can be developed. Symptomatology of the abuser, characteristics of the abused, and situational variables must be considered concurrently to strengthen prediction, develop effective prevention programs, and clarify treatment goals.     

The impact of child sexual abuse on health: A systematic review of reviews

A large amount of studies and literature reviews on the consequences of child sexual abuse has appeared over the past twenty years. To prevent that the inconsistency in their conclusions along with their methodological differences and limitations may create interpretative difficulties, mistaken beliefs, or confusion among all professionals who turn to this literature for guidance, this paper addresses the best available scientific evidence on the topic, by providing a systematic review of the several reviews that have investigated the literature on the effects of child sexual abuse. Seven databases were searched, supplemented with hand-search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus. Fourteen reviews, including more than 270,000 subjects from 587 studies, were analyzed. There is evidence that survivors of childhood sexual abuse are significantly at risk of a wide range of medical, psychological, behavioral, and sexual disorders. Relationships are small to medium in magnitudes and moderated by sample source and size. Child sexual abuse should be considered as a general, nonspecific risk factor for psychopathology. The implications for research, treatment, and health policy are discussed.     

Circumstances of sexual and physical victimization of black psychiatric outpatients

A sample of 54 adult psychiatric outpatients, previously identified as victims of sexual or physical assault, were interviewed regarding their childhood and adult victimization experiences. Patients were questioned about the nature of the assaults, their relationship to the perpetrator(s), the number of assaults suffered in each relationship, and whether the assault(s) occurred before or after the onset of their mental illness. Eighty percent of the sample had experienced major physical assault as an adult and 59% had experienced major physical assault as a child; 37% and 31%, respectively, reported major sexual assault as a child and as an adult. Women were more likely than men to report physical and sexual assault as an adult and sexual assault as a child. Childhood assault most often occurred before the onset of the patient's mental illness; whereas, adult sexual assault for women and physical and sexual assault for men was as likely to occur after the onset of the psychiatric disorder, suggesting an increased vulnerability to victimization for the adult mentally ill.     

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.     

A review of individual psychotherapy outcomes for adult survivors of childhood sexual abuse

This review examines the current literature on individual psychotherapy outcomes with adult survivors of childhood sexual abuse. As compared to the literature on treatment with victims of sexual trauma in adulthood, fewer researchers have explored the field of psychotherapy outcome with this population, particularly with regard to individual treatments. For this reason, a review of psychotherapy outcome for adult survivors of child sexual abuse is needed. This review first presents issues salient to the study of treatment with this population, such as prevalence, short-term impact, and long-term sequelae of childhood sexual trauma. Next, the eight studies that have been published on individual psychotherapy for this population are presented and evaluated according to both efficacy and effectiveness criteria for a methodologically sound study. Last, directions for future research with this population include continued integration of efficacy and effectiveness methodology, use of multi-method/multi-rater assessment data, as well as further investigation of interpersonal variables such as the therapeutic alliance.     

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.     

Advocacy Services for College Victims of Sexual Assault: Navigating Complicated Confidentiality Concerns

ABSTRACT

Recent policy reforms related to campus sexual assault may pose confidentiality concerns for victims. The current study aimed to understand current issues in providing confidential advocacy services for college victims of sexual assault, as well as the differential roles that campus-based and community-based advocacy play for college victims. For this qualitative study, semi-structured interviews were conducted with 22 national experts on campus sexual assault from a variety of disciplinary backgrounds. The results indicate that campus-based advocates face challenges in maintaining confidentiality of victims’ information, whereas community-based advocates are more likely to have legal confidentiality protections. Consequently, participants noted that an ideal advocacy model for college victims might be one in which campus- and community-based services are closely coordinated to ensure access to services that are both confidential and meet the unique needs of college students. Implications for advocacy services are discussed, as well as future directions for research and evaluation on the effects of evolving policy aimed at improving institutional responses to sexual assault.     

Predictors of psychological treatment noncompletion among sexual offenders

Research indicates that sexual offenders who do not complete their treatment are more likely to reoffend than are those who do complete it (Hanson et al., 2002; Losël & Schmucker, 2005). Several investigators have attempted to identify the characteristics of those individuals who do not complete treatment, most likely with the aim of preventing recidivism and the disastrous consequences that offenders' behavior has for their victims and for society at large. The objective of the present article is to review studies of treatment noncompletion among sexual offenders. We found that between 15% and 86% of sexual offenders do not complete treatment. In addition, results of the 18 studies reviewed diverge to the point where it is difficult to draw unequivocal conclusions about the variables related to the phenomenon. Only antisocial personality disorder and certain features of antisocial personality disorder appear to be related consistently and significantly to the discontinuation of treatment. These features are conceptualized under the three principles of effective treatment for general offenders. We present an analysis of the methodological limitations common to all of the studies reviewed in order to explain why confusion seems to reign supreme in the literature in this area at the present time, and we offer recommendations for future research in light of these limitations.     

Integrating General Strain Theory and Trauma-Informed Principles into the Study of Older Adult Victimization

ABSTRACT

Prevalence rates for late life victimization are well-documented. The literature has expanded, in part due to the identification of elder justice as a key priority for federal funding. The interdisciplinary field of criminology has begun addressing elder victimization and its consequences, informed by General Strain Theory (GST). It is challenging to connect the findings from this research to evidence-based interventions for older victims. Trauma-informed principles (TIP) – when linked with GST – offer a means for doing so. The current review contributes to the extant literature by examining connections between these perspectives, with the goal of encouraging future research, and ultimately informing treatment for older adult victims.     

Sexual assault and physical health: findings from a population-based study of older adults

OBJECTIVE: Prior reports have pointed to an adverse effect of sexual assault on subsequent health, particularly depression and obesity, in women. The objective of this study was to determine whether there is an association between self-reported sexual assault history and objective parameters of physical health in a sample of older men and women. METHODS: We conducted a cross-sectional study of white, middle to upper middle class, older (median age 75 years) men (N = 533) and women (N = 826) within a defined community setting. Sex-specific, age-adjusted risks were calculated for 11 common chronic medical conditions (10 for each sex: coronary heart disease, hypertension, diabetes, osteoporosis, obesity, asthma, migraine, thyroid disease, and arthritis in all subjects; breast cancer in women; and prostate cancer in men) and confirmed by physical or laboratory examination or review of medical records. RESULTS: Sexual assault was reported by 5.4% of men and 12.7% of women; repeated exposure was reported by 10.3 and 21.9% of sexually assaulted men and women, respectively. In women, a history of sexual assault was associated with an increased risk of 2 of 10 conditions: arthritis (OR = 1.76, 95% CI = 1.13-2.76) and breast cancer (OR = 2.21, 95% CI = 1.12-4.33). A "dose-response" effect was observed: Multiple episodes of sexual assault carried a two- to three-fold increased risk of these diseases compared with a single episode. In men, the only statistically significant association was between sexual assault and thyroid disease (OR = 4.68, 95% CI = 1.08-20.3). CONCLUSIONS: These data partially replicate findings from other studies of adverse effects of sexual trauma on health, although the specific diseases are different. Causal mechanisms cannot be inferred from these data. Studies in other cohorts are warranted.     

Non-epileptic seizures and child sexual abuse: a critical review of the literature

Non-epileptic seizures have received a substantial amount of attention in the psychiatric and medical literature, but comparatively little attention from psychologists. Non-epileptic seizures resemble epileptic seizures but lack the physiological symptoms of genuine epilepsy and are psychological in origin. Many authors have emphasized the role that child sexual abuse may play in the etiology of this disorder. In the present paper, we provide a review of 34 studies examining this relationship, followed by a meta-analysis of 19 effect sizes. While our statistical results support the professed link between child sexual abuse and non-epileptic seizures, we suggest that because of research design limitations, it is premature to draw any definitive conclusions regarding a relationship. Eight of these research design limitations are identified and discussed (e.g., the absence of comparison groups; an explicit and public definition of child sexual abuse). Alternatives to a traditional psychoanalytic perspective that emphasizes the role of child sexual abuse in the etiology of NES are presented. Specific recommendations for future research are made and psychologists are strongly encouraged to play a more active role in both researching and treating non-epileptic seizures.     

Sexual dysfunction and cardiovascular diseases: a systematic review of prevalence

The aim of this study was to conduct a systematic review of the literature regarding the prevalence of sexual dysfunction in patients with cardiovascular diseases. An article search of the ISI Web of Science and PubMed databases using the search terms "sexual dysfunction”, “cardiovascular diseases”, “coronary artery disease", “myocardial infarct" and “prevalence” was performed.In total, 893 references were found. Non-English-language and repeated references were excluded. After an abstract analysis, 91 references were included for full-text reading, and 24 articles that evaluated sexual function using validated instruments were selected for this review. This research was conducted in October 2012, and no time restrictions were placed on any of the database searches. Reviews and theoretical articles were excluded; only clinical trials and epidemiological studies were selected for this review.The studies were mostly cross-sectional, observational and case-control in nature; other studies used prospective cohort or randomized clinical designs. In women, all domains of sexual function (desire, arousal, vaginal lubrication, orgasm, sexual dissatisfaction and pain) were affected. The domains prevalent in men included erectile dysfunction and premature ejaculation and orgasm.Sexual dysfunction was related to the severity of cardiovascular disease. When they resumed sexual activity, patients with heart disease reported significant difficulty, including a lack of interest in sex, sexual dissatisfaction and a decrease in the frequency of sexual activity.     

A review of empirical rape research: Victim reactions and response to treatment

The purpose of the following paper is to review results of recent empirical studies on victim reactions following rape and response to treatment. Results focus on three major research projects run concurrently in Atlanta, Pittsburgh and Charleston, as well as several smaller studies. The Atlanta study is described in detail and sampling bias is discussed. Short-term reactions are described and defined as those occurring during the first 3 months post-assault. During this time, most symptoms return to normal levels in most victims. Intermediate reactions, 3 months to one year post-assault, are described under four headings: depression, social adjustment, sexual functioning, and fear and anxiety. At the end of this interval, victims still score significantly higher than nonvictims on measures of fear and anxiety. Long-term reactions, defined as those continuing longer than one year post-assault, are discussed under four headings. No firm conclusions can be drawn as to the long-term symptoms experienced by victims versus nonvictims. Section IV reviews factors associated with adjustment to the assault. Factors within the rape situation are not clearly predictive of adjustment, but psychiatric history prior to the assault and amount of social support following the assault are predictive. In section V, empirical studies of behavior therapy with rape victims are reviewed. While all these studies were successful, they suffer from methodological flaws. Difficulties in doing rape research are discussed. Lastly, section VI offers a theoretical explication which draws on crisis theory to account for short-term and intermediate reactions and differential rates of recovery, and which draws on classical conditioning theory to account for continued high levels of fear and anxiety and selective anhedonia.     

Sexual risk behavior among HIV-positive men who have sex with men: a literature review

OBJECTIVE: To review research on sexual risk behavior among HIV-positive men who have sex with men (MSM) after the year 2000. METHOD: The review included 53 published studies that reported on unprotected anal intercourse (UAI) in cross-sectional and longitudinal surveys of HIV-positive MSM and MSM of mixed HIV status. RESULTS: The findings indicate high levels of UAI among HIV-positive MSM, particularly with HIV-negative or HIV status unknown partners. In studies of MSM of mixed HIV status, we found that the rate of UAI among HIV-positive MSM was much higher than that of HIV-negative MSM. Furthermore, the prevalence of UAI among HIV-positive MSM has increased in recent years. CONCLUSION: Although studies indicate that HIV-positive MSM have adopted risk reduction strategies, roughly two in five HIV-positive MSM continue to engage in UAI, which represents a risk for continued HIV and STI (sexually transmitted infection) transmission. PRACTICE IMPLICATIONS: Prevention efforts targeting HIV-positive MSM to assist them in adopting and maintaining safer sexual behaviors need to be intensified.     

Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health

Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews.     

Sexual assault and other types of sexual harassment by workplace personnel: a comparison of antecedents and consequences

Although sexual assault by workplace personnel is widely viewed as a type of sexual harassment, little is known about whether these overlapping constructs may possess some unique characteristics. This article compares the theoretical antecedents and consequences of sexual assault by workplace personnel and other types of sexual harassment among 22,372 women employed in the U.S. military. Path analysis revealed that low sociocultural and organizational power are associated with an increased likelihood of both types of victimization. Organizational climate and job gender context are directly associated with sexual harassment but are only indirectly associated with sexual assault by workplace personnel. Both types of victimization are associated with a variety of negative outcomes, but the pattern of negative consequences differs.