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
Some qualities of people who perpetrate these crimes?
(basically they are complicated)
- Are controlling and possessive
- Feel entitled
- Twist things into opposites (victim may think she is at fault)
- Disrespect partner and consider themselves superior
- Confuse love and abuse
- Are manipulative
-Strive to have good public image
-Deny and minimize abuse
Is couples therapy an effective way to decrease inter-partner violence in a relationship?
IMPORTANT
Because of the characteristics of batterers and the dynamics of the power and control relationship, couples therapy or counseling is usually not effective and often very unsafe for the victim.
What are some s/s of abuse we should consider?
- Bruising/burns
- Malnutrition
- Frequent illness/lack of medical care
- Isolated from family/friends
- Extreme anxiety
- Depression
- Strong emotions/Mood extremes
- Neglect
- STDs
- Recurring risk behavior or lack of safety precautions.
What is the only way to actually stop the abuse?
When is the most dangerous time for a victim?
Supporting victims who come forward, and holding the perp accountable is the only way to actually stop the abuse.
Most dangerous time for a victim is when she is leaving. It may be safer for her to stay. The victim is the best expert at determining her level of safety and determining how to survive.
No judgment, no victim-blaming.
Phrases for responding to a victim’s story?
“I’m concerned about you. Is everything OK?”
“I will be happy to listen if you want to talk.”
“I am so sorry that happened to you”
“What happened was NOT your fault.”
“I believe you, and will do whatever I can to help.”
“You don’t have to go through this alone.”
“I can give you a number for WISE.”
