Introduction
Sexual assault of women is a pervasive crime that exerts significant influence both on the lives of women, who become victims of gender-based violence, and the communities, where these women live (Klump, 2006, p.67). Sexual assault against women is epidemic to American culture (Miller, Markman and Handley, 2007, p.129). A woman can face a sexual assault both in childhood and adulthood. Different kinds of both physical and mental diseases tend to be prevalent in women, who have experienced sexual assault or another kind of gender-based violence in childhood or adulthood. The women also tend to report specific emotional conditions, such as self-blame and issues, associated with the process of sexual revictimization that cannot be qualified as either physical or mental health issue. The peculiarity of the issue under study lies in the fact that sexual assault is often underreported, and the data concerning gender-based violence are frequently not full.
This paper is aimed at reviewing the literature that highlights the prevalence of particular kinds of mental health issues in women with sexual assault experience.
Depression
Depression is one of severe healthcare-related issues in modern society. Depression already makes a significant contribution into the global burden of diseases. Victims of depression often avoid reporting their mental health state. Thus, frequency and nature of depression in women, who have experienced sexual assault, can only be estimated. Depression is often seen as a consequence of negative life experiences. The lifetime depression cases may occur if a person has been experienced a combination of negative life situations, such as childhood abuse, difficulties in intimate relations, alcohol and drugs abuse, etc.
Depression may have various symptoms, nature and the degree of severity. The most wide-spread symptoms of depression relate to the loss of interest in daily activities, low self-esteem and a lack of belief in oneself and one’s capabilities. The multifaceted research of depression in women, conducted by D.Western (2013), is aimed at investigating the gender-related causes of depression among women. The author considers biological, biomedical, psychological, cognitive, relational and psychosocial explanations of depression in females. After having investigated different aspects of depression-related explanations, the author came to the conclusion that depression in women is often caused by the experience of gender-based violence and the way women perceive it (Western, 2013, p.56). The author pays particular attention to the role of the concept of self in the understanding the nature and impact of depression on women’s health.
It is suggested that women may have both authentic and false selves, being incapable of distinguishing the authentic one from the false ones. So, the women, who have experienced assault, feel constrained and captured by beliefs, roles, expectations and assumptions that do not let them feel free from their previous experiences. In this regard, it is important for a psychologist to get an insight into the barriers that prevent women from recovery after a traumatic experience and distinguish the authentic identity from the false ones.
The investigation of depression after a sexual assault among women, developed by N.Abrahams, R.Jewkes and S.Mathews (2013), is aimed at researching into the impact the assault-related factors exert on the degree of the depression’s severity. The sample group was constituted of 140 participants from public health services, receiving the post exposure prophylaxis. 84.3 percent of the women were found to experience severe depression symptoms. The investigation of the circumstances of sexual assault and the mental health-related consequences of the assault showed that the severity of depression is not dependent on the degree of violence that accompanies sexual assault.
However, it was empirically found that it is more important to consider socio-cultural dimensions of the issue under study, including the dynamics of blame and stigma development and their influence on the women’s perception of self (Abrahams, Jewkes &.Mathews, 2013, p.292-293). It is also crucial to take into account the relations that existed between the victim and the perpetrator before sexual assault.
Self-blame
Becoming of a victim of sexual assault is sometimes followed by a period of revictimization. Revictimization period is often characterized by difficult emotional states, associated with the disharmony of woman’s past and present perception of self. The research work by Miller, Markman and Handley (2007) focuses on the analysis of self-blame phenomenon, and the relationships among sexual assault, self-blame and sexual revictimization. The authors found out that the female sexual assault victims, who failed to change their own perception of self and experience intense self-blame feeling, were at an increased risk of sexual revictimization short after their first sexual assault experience. Furthermore, the victims, who were likely to blame themselves for their own assaults, demonstrated greater potential for the escalation of depressive symptoms (Miller, Markman&Handley, 2007, p.135-136).
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is one of the forms of anxiety disorders that occurs after a person has gone through an extreme emotional trauma that involved the threat of severe injury or death. The most wide-spread symptoms of PTSD include reliving the event as a day-to-day activity (e.g., upsetting memories, nightmares), avoidance (feeling detached, uninterested in daily activities, avoiding visiting places and meeting people, who may remind about the event etc.) and hyper arousal (the lack of concentration, headaches, heartaches etc.). The research shows that different symptoms of PTSD are often prevalent in women, who have come through sexual assault.
The investigation of PTSD severity and health perceptions in female victims of sexual assault by L.Zoellner, M.Goodwin and E.Foa (2000) was conducted in the group of 76 female victims of PTSD, who have been experiencing PTSD symptoms for at least three months. The authors used a broad range of measures to research into the interrelations between the sexual assault experience and PTSD symptoms among the victims, such as Structured Clinical Interview, PTSD symptom scale, Standardized Assault Interview. The results of the study affirmed significant severity of PTSD symptoms among the female victims of sexual assault. The most wide-spread symptom of PTSD in victims of sexual assault was continuous recollection of traumatic events.
One of most important suggestions with regard to the empirical research was that PTSD severity was strongly interrelated with poor physical health (Zoellner, Goodwin,.Foa, 200, p.645). Crucial nature of this finding is associated with the fact that it helps psychiatrists and psychologists pay more attention to somatic context of PTSD and apply a more complex approach to treating PTSD.
Reinvestigation of the research work by Klump (2006) affirms the increased likelihood of PTSD development in female victims of sexual assault. Having studies other risk factors that may accompany sexual assault, the author names the history of previous abuse, alcohol abuse, lifetime depression and issues, associated with interpersonal relations as key prerequisites to the development of chronic PTSD.
While Zoellner, Goodwin and Foa (2000) suggest paying more attention to somatic context of the PTSD development, Klump (2006) emphasizes the need of studying the history of a person’s victimization and the nature of a person’s emotional responses, attributions of blame (and self-blame) and beliefs (p. 80). As a result of research work, Klump manages to formulate an important conclusion concerning the nature of PTSD in the female victims of sexual assault. According to Klump (2006), chronic PTSD represents a complex interaction of the individual’s character features, variables of the trauma and its consequences (p.80).
One of the most wide-spread theory of PTSD is Ehlers and Clark’s cognitive model that suggests that the development of PTSD and the severity of the disorder is determined by the victim’s appraisals related to the threat. The issue is that the PTSD disorder relates to the past, and the threat, associated with it, also relates to the past. Thus, the severity of the condition is determined by the victim’s perception of the threat, and the causal role of threat-relevant cognitions with regard to emotional disorders needs to be emphasized.
The research of PTSD in victims of sexual assault, performed by Fairbrother and Rachman (2006) was aimed at testing the major components of Ehlers and Clark’s PTSD cognitive model in cases of women with the experiences of sexual assault.
The results of the empirical research showed that the victims’ appraisals of sexual assault experience demonstrate strong and positive relation to the symptoms of PTSD (Fairbrother&Rachman, 2006, p.91-92). These findings let researchers get convinced of the complex nature of PTSD, and the interrelations between so-called traumatic memory and the severity of the condition.
PTSD is one of most wide-spread mental health-related consequences of sexual assault. Modern research shows that each PTSD case in a female victim of sexual assault is characterized by the unique complex of emotional, social, mental and somatic contests. Thus, the treatment of PTSD needs to be based on the multifaceted approach towards the wellbeing of a person and cooperation of physicians, psychologists and psychiatrists.
Suicidal thoughts
Pervasive suicide-related thoughts and attempts testify to important mental health issues and a woman’s experiencing the state of disharmony, and the loss of interest in daily activities. Various studies were designed in order to get an insight into the relation between sexual assault experiences in both childhood and adulthood, and suicidal thoughts. The multifaceted study, developed by S.Ullman and L.Brecklin (2002), shows that women with histories of sexual abuse in both childhood and adulthood tend to report significantly greater odds of suicide attempts over the lifetime. The authors find this conclusion predictable, and state that suicidal thoughts can be viewed as a consequence of not only sexual assault experiences, but a combination of various factors.
Among them the authors mention stressful lifetime events, depression, PSTD and alcohol dependence (Ullman&Brecklin, 2002, p.129-130). Furthermore, the results of the research suggest that the number of suicide attempts is strongly dependent on the number and severity of suicidal behavior-related risks.
Childhood sexual abuse has long been believed to be an important risk factor for suicidal ideation. However, recent research on the incidence and consequences of childhood and adolescence sexual assault challenges the long-held assumptions, regarding the impact of sexual molestation experience on the future life of the female victim of sexual assault. While it is evident that the experience of childhood sexual abuse may have the long-term impact on the psychopathology and suicidal behavior, the degree to which this risk may be mediated by depression in female victims of sexual assault remains unclear.
The results of the empirical research by Bedi et al. (2011), show that childhood sexual abuse is strongly related to PTSD, depression and suicidal behavior risks (p. 415). In order to research into the degree to which childhood sexual abuse-related risks may be mediated, the authors used the Childhood Trauma Study computer-assisted diagnostic interview and a range of other assessment tools.
However, more detailed investigation of the prevalence of particular mental health conditions (e.g., depression, PTSD), showed that these disorders may partially mediate the risks that stem from childhood sexual abuse. The analyses of childhood sexual abuse survivors’ experience allowed to conclude that sustained control over the effects of childhood sexual abuse (e.g, depression, PTSD) minimizes suicidal ideation (Bedi et al, 2011, p.416).
Limitations
It is widely known that the victims of sexual assault tend either not to report or underreport gender-based violence and related mental health issues. Thus, it is still quite hard to get to know the real number of the women, who had experienced gender-based violence and suffered from its effects. The lack of quantitative data makes it hard to estimate the prevalence of particular mental health issues among the women, who have experienced sexual assault. There is also a lack of data concerning previous experiences of victims of sexual assault and their relation to the development of particular mental health conditions in the victims. These data could be helpful with regard to getting-to-know the degree of interdependence between sexual assault experience and further development of mental health conditions. One more issue to mention is that the vast majority of the works that investigate mental health issues in women, who have experienced sexual assault, concern childhood sexual abuse.
Conclusion
Sexual assault is one of important risk factors, associated with both physical and mental health. Both childhood and adulthood sexual assaults are likely to cause a variety of pervasive emotional states (such as self-blame), as well as mental health issues (e.g., depression, PTSD, suicidal ideation). When researching into the effects of sexual assault, it is important to consider the effects in various contexts, such as physical health, mental health, social interactions, self-perception and the risk of possible sexual revictimization. The results of several empirical investigations show that the mental health issues are tightly interconnected with the state of physical health, emotions and social support.
While persistent emotional states (such as self-blame) cannot be considered as mental health issues, they can further reach the level of depression and even post-traumatic stress disorder. These mental health conditions can have different forms. However, both depression and post-traumatic stress disorder are characterized with avoidance and the loss of interest in daily activities. Long-term depression and PTSD can result in active suicidal ideation. The important notice regarding suicidal ideation lies in the fact that the degree of its incidence and severity is not related to the degree of the event’s violence. At the same time, a particular role is played by the degree to which a female victim of sexual assault blames herself for her assault.
References
Abrahams, N., Jewkes, R., Mathews, R. (2013). Depressive symptoms after a sexual assault among women: understanding victim-perpetrator relationships and the role of social perceptions.Afr J Psychiatry, 16(4), pp.288-293
Bedi, S., Nelson, E.C., Lynskey, M.T., McCutcheon, V.V., Heath, A.C., Madden, P.A.M. and Martin, N.C. (2011). Risk of suicidal thoughts and behavior after childhood sexual abuse in women and men. Suicide Life Threat Behavior, 41(4), pp.406-415
Fairbrother, N. & Rachman, S. (2006). PTSD in victims of sexual assault: A test of a major component of the Ehlers-Clark theory. Journal of Behavior Therapy and Experimental Psychiatry, 37, 74-93.
Klump, M.C. (2006). Post-traumatic stress disorder and sexual assault in women. Journal of college student psychopathology, 21(2), pp.67-83
Miller, A., Markman, K., Handley, I.M. (2007). Self-blame among sexually assault prospectively predicts revictimization: a perceived sociolegal model of risk. Basic and applied social psychology, 29(2), pp.129-136
Ullman, S., Brecklin, L.R. (2002). Sexual Assault History and Suicidal Behavior in a National Sample of Women. Suicide Life Threat Behavior, 32(2), pp.117-130
Western, D. (2013). Gender-based Violence and Depression in Women: A Feminist Group Work Response. Berlin: Springer Science & Business
Zoellner, L.A., Goodwin, M.L., Foa, E.B.(2000). PTSD severity and health perceptions in female victims of sexual assault. Journal of Traumatic Stress, 13(4), pp. 635-649
