4/22 Adult Sexual Abuse Flashcards
Define adult sexual abuse
From what we know, who is generally the perp v victim?
Definition:
non-consensual sexual contact by coercion, physical force, threat of bodily harm, or when consent not possible (e.g., mental illness, mental retardation, intoxication)
Most assaults are committed by men against women.
Define sexual violence.
(impt to think of sexual violence and abuse more broadly than just physical acts)
A range of cultural messages and personal behaviors which includes coercion, manipulation, pressure, and violence that violates personal boundaries and/or person’s right to choose, with the intent of gaining power and control over another person.
- any sexual act with someone who, for any reason, cannot consent or refuse.
- any act of violence where sex is a weapon
- any form of non-consensual sexual activity
- any sexual act one is forced to perform
What % of women have unwanted sexual contact prior to age 18? what is the incidence of rape?
Most acts committed by someone known or unknown to victim?
What is the association with EtOH/other drugs?
Unwanted sexual contact prior to age 18: 20-25% women
Incidence of rape: 5-45%
75% of acts committed by acquaintance
Majority of rapes associated with EtOH or other drugs
What % rapes are reported?
What women are esp vulnerable to abuse?
Both men and women have what reaction to sexual assault?
What % rapes are reported? < half
What women are esp vulnerable to abuse? women with disabilities
Both men and women have what reaction to sexual assault? PTSD
What is the social context in which sexual violence occurs? what are our day to day opportunities?
Social context in which women are victims. About power and violence expressed as sex.
Opportunities to respond to sexist jokes or language, to refuse to purchase or consume sexist images, etc.
What are the health consequences of sexual violence – acute? chronic?
Acute:
distress, extreme fear, anxiety. then depression, exhaustion, restlessness. peaks at approx 3 weeks
Chronic:
PTSD. suicidal thoughts, depression, anxiety, somatization, substance abuse, flashbacks, nightmares, intrusive thoughts
More health consequences of abuse?
re: relationships, pain, behaviors, use of medical services, cardiovascular status
- Disruption of relationships, including sexual dysfunction
- Recurrence of symptoms (anxiety, dissociation, flashbacks) during pelvic exams, delivery of a child
-Chronic pain, particularly vaginal, pelvic, abdominal
- Hypersexuality, revictimization - increased rates STD’s, unwanted pregnancies, multiple partners
- Overall increased use of medical services
- Lower health status and increased somatic symptoms
- Changes in cardiovascular reactivity; autonomic hyperarousal; disturbed sleep; adrenergic, opioid, and immune dysregulation, altered hypothalamic-pituitary-adrenal and thyroid functions
Evaluation and Documentation: what are some important considerations?
- Take a careful/accurate history
- Provide privacy/support for victim
- Obtaining consent is crucial to victim’s sense of control
- Consider chain of evidence
- Encourage reporting to police
- Document injuries: both on body and emotional response
What are elements of a complete physical exam after a rape?
DNA = new gold standard. Try to find it in these places….
- Evidence of ejaculate: oral, skin, genital, rectal areas
- Hair combings, fingernail scrapings
- Clothing
- Get victim’s buccal swab for DNA identification
What is a good treatment response in regards to….
- STD/pregnancy prevention
- Support agencies
- consider post-exposure prophylaxis for HIV
- emerg contraception for preg?
- involve support agencies, possibly police
- set up followups for counseling and medical
A few assumptions/theories that may be held by rapists?
- Power, anger, sadism
- Implicit theories:
–Women are dangerous
–Women are sex objects
–Male sex drive is uncontrollable
–Men are entitled to sex
A few social realities that contribute to the rape culture?
- Human trafficking for sexual exploitation
- Rape as part of interpersonal (“domestic”) violence
- Rape as a crime of war and means of genocide
Sexual assault is…. (general commentary)
- Medical, psychological and legal emergency
- Common, though hidden crime
- Source of long-term health consequences
- Trigger for specific care from doctors and nurses: empathy, long-term support, and coordination with other services
Define interpersonal violence
A pattern of coercive and abusive behaviors committed against a current or former intimate partner to gain or maintain power and control over the other.
Ways in which power and control can be gained against another person?
- Coercion and threats
- Intimidation
- Emotional Abuse
- Isolation
- Minimizing, Denying, Blaming
- Using Children
- Using Male Privilege
- Economic Abuse
