Rape Crisis Syndrome

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Basics

Description

  • Definitions (vary by jurisdiction on local, state, and national levels):
    • Rape (a legal term), sexual assault (a medical term), or sexual violence (a general term): any form of sexual activity that occurs without consent between a victim and perpetrator(s)/suspect(s)
    • Rape/sexual assault/sexual violence: may be associated with the use of force and/or threats, alcohol, and/or illicit and/or prescription drugs
    • Intimate partner violence (IPV): aggression and/or abuse that occurs within a close relationship between a current or former dating partner and/or spouse that can include the following types of behavior:
      • Sexual violence
      • Physical violence
      • Psychological aggression
      • Stalking
    • Military sexual trauma (MST): any form of sexual activity (or sexual harassment) that occurs without consent between a victim and perpetrator(s)/suspect(s) during military service
    • Rape crisis syndrome is a historical term that has previously been utilized to define what is now known as an acute stress reaction (ASR), acute stress disorder (ASD), and/or a post-traumatic stress disorder (PTSD) in persons exposed to sexual violence.
      • Pyschological responses to sexual violence, identical to other forms of trauma, can range anywhere from transient and non-debilitating to chronic and debilitating.
      • The neurobiology and traumatic impact of sexual violence on victims is complex; associated with a profound flight, fight, and/or freeze-related fear response as well as hormonal cascade (involving catecholamines, cortisol, opiates, and oxytocin) and the use of primitive brain structures (e.g., the prefrontal cortex, amygdala, hippocampus) and can trigger the development of numerous post-traumatic psychological, emotional, physical, and social effects
    • Acute stress reaction (ASR): a transient reaction to traumatic stress (e.g., sexual violence) that may develop simultaneously with and/or last less than 3 days after a traumatic event; may be temporarily debilitating but resolves rapidly with simple measures (e.g., reassurance, ensuring safety, and/or rest); not a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnosis
    • Acute stress disorder (ASD): an acute reaction to traumatic stress (e.g., sexual violence) that has a duration of 3 days to 1 month with symptoms that result in functional impairment and/or cause significant distress; see the DSM-5 for further diagnostic criteria.
      • Diagnostic clusters of symptoms include: intrusion symptoms, arousal symptoms, dissociative symptoms, negative mood, and avoidance symptoms
    • Post-traumatic stress disorder (PTSD): a chronic reaction to traumatic stress (e.g., sexual violence) that has a duration of greater than 1 month with symptoms that result in functional impairment and/or cause significant distress; see the DSM-5 for further diagnostic criteria.
  • Common sequelae of sexual violence: physical injuries (e.g., contusions and lacerations), pyschological conditions (e.g., ASR, ASD, PTSD, depression, anxiety, suicial and/or homicidal ideation(s), eating and/or sleeping disorders, substance and/or alcohol abuse, a decreased self-esteem/worth/confidence), reproductive concerns (e.g., unplanned pregnancy, sexually transmitted infections [STIs] sexual dysfunction), and somatic reactions (e.g., chronic pelvic pain and/or headaches, recurrent abdominal pain, fibromyalgia)

Epidemiology

  • In United States, more than 33% of women and nearly 25% of men have reported experiencing sexual violence during their lifetimes.
  • ~1.5 million women and 834,700 men are victims of sexual violence annually in the U.S.
  • Legal and medical care-related expenses associated with sexual violence cost the U.S. more than $127 billion per year, which exceeds every other form of crime.
  • The following populations are especially vulnerable:
    • Adolescents and young children
    • Persons with disabilities
    • Elderly adults
    • Those with a low socioeconomic status and/or that are homeless
    • Sex workers
    • People living in institutions/areas of conflict/training environments
  • Predominant age
    • The incidence of sexual violence peaks in those 11 to 24 years of age
      • Adolescent victims of sexual violence have a greater frequency of anogenital injuries
  • Predominant sex: female > male
    • Females:
      • 33% of female victims first experienced sexual violence before age 18; 13% of whom first experienced it before age 10
    • Males:
      • 25% of male victims first experienced sexual violence before age 18; 25% of whom first experienced it before age 10
  • Only 16–38% of victims of sexual violence report to law enforcement, and 17–43% of victims obtain a medical evaluation.
  • 33% of victims of sexual violence never report it to their primary care providers.
  • Most victims of sexual violence know or have had an acquaintance with their perpetrators/suspects.
  • Episodes of sexual violence for both male and female victims have predominantly resulted from male perpetrators/suspects.
  • Nearly 50% of all episodes of sexual violence have been associated with alcohol use.

Risk Factors

  • History of sexual violence, psychological aggression, physical violence, and/or stalking
  • Early initiation of sexual activity
  • Engagement in high-risk sexual behavior
  • Exposure to familial and/or environmental violence
  • Consumption of alcohol
  • Use of illicit drugs
  • Belief in traditional gender roles

General Prevention

  • Primary prevention: Promoting gender equality, teaching skills to prevent sexual violence, providing opportunities to empower and support women and girls, and creating protective environments.
    • Strategies include mobilizing men and boys as allies, empowering bystanders, teaching social-emotional learning and safe intimate relationship skills, promoting health sexuality, strengthening economic supports and leadership opportunities for girls and women, and improving safety and monitoring in schools, workplaces, and communities.
  • Secondary prevention: The United States Preventive Services Task Force (USPSTF) recommends screening all women of childbearing age for intimate partner violence (IPV) and referring women who screen positive for interventional services.
    • The HARK screening tool, which includes questions that assess if a patient has felt humiliated (H) and/or afraid (A), and been raped (R) and/or kicked (K) within the past year, is 81% sensitive and 95% specific for IPV; as well as clinically useful (1)[B].

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Basics

Description

  • Definitions (vary by jurisdiction on local, state, and national levels):
    • Rape (a legal term), sexual assault (a medical term), or sexual violence (a general term): any form of sexual activity that occurs without consent between a victim and perpetrator(s)/suspect(s)
    • Rape/sexual assault/sexual violence: may be associated with the use of force and/or threats, alcohol, and/or illicit and/or prescription drugs
    • Intimate partner violence (IPV): aggression and/or abuse that occurs within a close relationship between a current or former dating partner and/or spouse that can include the following types of behavior:
      • Sexual violence
      • Physical violence
      • Psychological aggression
      • Stalking
    • Military sexual trauma (MST): any form of sexual activity (or sexual harassment) that occurs without consent between a victim and perpetrator(s)/suspect(s) during military service
    • Rape crisis syndrome is a historical term that has previously been utilized to define what is now known as an acute stress reaction (ASR), acute stress disorder (ASD), and/or a post-traumatic stress disorder (PTSD) in persons exposed to sexual violence.
      • Pyschological responses to sexual violence, identical to other forms of trauma, can range anywhere from transient and non-debilitating to chronic and debilitating.
      • The neurobiology and traumatic impact of sexual violence on victims is complex; associated with a profound flight, fight, and/or freeze-related fear response as well as hormonal cascade (involving catecholamines, cortisol, opiates, and oxytocin) and the use of primitive brain structures (e.g., the prefrontal cortex, amygdala, hippocampus) and can trigger the development of numerous post-traumatic psychological, emotional, physical, and social effects
    • Acute stress reaction (ASR): a transient reaction to traumatic stress (e.g., sexual violence) that may develop simultaneously with and/or last less than 3 days after a traumatic event; may be temporarily debilitating but resolves rapidly with simple measures (e.g., reassurance, ensuring safety, and/or rest); not a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnosis
    • Acute stress disorder (ASD): an acute reaction to traumatic stress (e.g., sexual violence) that has a duration of 3 days to 1 month with symptoms that result in functional impairment and/or cause significant distress; see the DSM-5 for further diagnostic criteria.
      • Diagnostic clusters of symptoms include: intrusion symptoms, arousal symptoms, dissociative symptoms, negative mood, and avoidance symptoms
    • Post-traumatic stress disorder (PTSD): a chronic reaction to traumatic stress (e.g., sexual violence) that has a duration of greater than 1 month with symptoms that result in functional impairment and/or cause significant distress; see the DSM-5 for further diagnostic criteria.
  • Common sequelae of sexual violence: physical injuries (e.g., contusions and lacerations), pyschological conditions (e.g., ASR, ASD, PTSD, depression, anxiety, suicial and/or homicidal ideation(s), eating and/or sleeping disorders, substance and/or alcohol abuse, a decreased self-esteem/worth/confidence), reproductive concerns (e.g., unplanned pregnancy, sexually transmitted infections [STIs] sexual dysfunction), and somatic reactions (e.g., chronic pelvic pain and/or headaches, recurrent abdominal pain, fibromyalgia)

Epidemiology

  • In United States, more than 33% of women and nearly 25% of men have reported experiencing sexual violence during their lifetimes.
  • ~1.5 million women and 834,700 men are victims of sexual violence annually in the U.S.
  • Legal and medical care-related expenses associated with sexual violence cost the U.S. more than $127 billion per year, which exceeds every other form of crime.
  • The following populations are especially vulnerable:
    • Adolescents and young children
    • Persons with disabilities
    • Elderly adults
    • Those with a low socioeconomic status and/or that are homeless
    • Sex workers
    • People living in institutions/areas of conflict/training environments
  • Predominant age
    • The incidence of sexual violence peaks in those 11 to 24 years of age
      • Adolescent victims of sexual violence have a greater frequency of anogenital injuries
  • Predominant sex: female > male
    • Females:
      • 33% of female victims first experienced sexual violence before age 18; 13% of whom first experienced it before age 10
    • Males:
      • 25% of male victims first experienced sexual violence before age 18; 25% of whom first experienced it before age 10
  • Only 16–38% of victims of sexual violence report to law enforcement, and 17–43% of victims obtain a medical evaluation.
  • 33% of victims of sexual violence never report it to their primary care providers.
  • Most victims of sexual violence know or have had an acquaintance with their perpetrators/suspects.
  • Episodes of sexual violence for both male and female victims have predominantly resulted from male perpetrators/suspects.
  • Nearly 50% of all episodes of sexual violence have been associated with alcohol use.

Risk Factors

  • History of sexual violence, psychological aggression, physical violence, and/or stalking
  • Early initiation of sexual activity
  • Engagement in high-risk sexual behavior
  • Exposure to familial and/or environmental violence
  • Consumption of alcohol
  • Use of illicit drugs
  • Belief in traditional gender roles

General Prevention

  • Primary prevention: Promoting gender equality, teaching skills to prevent sexual violence, providing opportunities to empower and support women and girls, and creating protective environments.
    • Strategies include mobilizing men and boys as allies, empowering bystanders, teaching social-emotional learning and safe intimate relationship skills, promoting health sexuality, strengthening economic supports and leadership opportunities for girls and women, and improving safety and monitoring in schools, workplaces, and communities.
  • Secondary prevention: The United States Preventive Services Task Force (USPSTF) recommends screening all women of childbearing age for intimate partner violence (IPV) and referring women who screen positive for interventional services.
    • The HARK screening tool, which includes questions that assess if a patient has felt humiliated (H) and/or afraid (A), and been raped (R) and/or kicked (K) within the past year, is 81% sensitive and 95% specific for IPV; as well as clinically useful (1)[B].

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