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Sarah is a woman who was out with friends a few months ago and she was . She a disability and has social support in the form of friends and family. She seeks out a health care provider because she is experiencing symptoms.
Would you respond differently to Sarah based on changing elements in this scenario? Would your approach to her care change? If so, in what ways?
Age
Young
Women aged 15-24 are at higher risk for sexual assault than women 55+iiiiii
Reported mean age of sexual assault ranges from 20-25 for womenivvviviiviiiixxxixii
Some research suggests that female students may be at highest risk for sexual assaultxiiixiv but other research reports rates of sexual assault are 1.2 times higher for nonstudents than studentsxv
Grossin C, Sibille I, Lorin De La Grandmaison G, Banasr A, Brion F, Durigon M. Analysis of 418 cases of sexual assault. Forensic Science International 2003;131(2e3):125e30
Hwa H-L, Chen S-C, Wu M-Z, Shun C-T, Liu S-K, Lee JC-I, et al. Analysis of cases of sexual assault presenting at a medical center in Taipei. Taiwanese Journal of Obstetrics Gynecology 2010;49(2):165e9, http://dx.doi.org/10.1016/S1028-4559(10)60035-6.
Ingemann-Hansen O, Brink O, Sabroe S, Sørensen V, Charles AV. Legal aspects of sexual violenceedoes forensic evidence make a difference? Forensic Science International 2008;180(2e3):98e104, http://dx.doi.org/10.1016/j.forsciint.2008.07.009
Ingemann-Hansen O, Sabroe S, Brink O, Knudsen M, Charles AV. Characteristics of victims and assaults of sexual violenceeimproving inquiries and prevention. Journal Of Forensic And Legal Medicine 2009;16(4):182e8, http://dx.doi.org/10.1016/j.jflm.2008.07.004.
Jänisch S, Meyer H, Germerott T, Albrecht U-V, Schulz Y, Debertin AS. Analysis of clinical forensic examination reports on sexual assault. International Journal of Legal Medicine 2010;124(3):227e35, http://dx.doi.org/10.1007/s00414-010-0430-z.
Nannini A. Sexual assault patterns among women with and without disabilities seeking survivor services. Womens Health Issues 2006;16(6):372e9.
Portero G, Abasolo AE, De Francisco ML, Sudupe A, Hidalgo A. Trabajo empírico. Agresiones y Abusos sexuales en Bizkaia. In: Víctimas. Bienio 2009-2010. Vitoria-Gasteiz: Servicio Central de Publicaciones del Gobierno Vasco; 2011 (pp.181e226).
Read KM, Kufera JA, Jackson MC, Dischinger PC. Population-based study of police-reported sexual assault in Baltimore, Maryland. The American Journal of Emergency Medicine 2005;23(3):273e8.
Riggs N, Houry D, Long G, Markovchick V, Feldhaus K. Analysis of 1,076 cases of sexual assault. Annals of Emergency Medicine 2000;35(4):358e62, http://dx.doi.org/10.1016/S0196-0644(00)70054-0.
Fisher, B., Cullen, F., & Turner, M. (2000). The sexual victimization of college women: Findings from two national-level studies. Washington, DC: National Institute of Justice and Bureau of Justice Statistics
Among women aged 31-54 reporting sexual assault to a Sexual Assault/Domestic Violence Care Centre in a metropolitan area in Ontario, Canadaxvi:
Almost 50% were single, 25% were married/common-law and 22% were divorced/separated
33% lived with family, 26% lived alone, 18% lived in a shelter/homeless
Almost half of the women had histories of psychological difficulties
Sexual assault location:
29% at the assailant’s home
26% in a park/outside
20% at the victim’s home
6% in a vehicle
3% at an institution
Del Bove, G., Stermac, L., & Bainbridge, D. (2005). Comparisons of sexual assault among older and younger women. Journal of Elder Abuse & Neglect, 17(3), 1-18. doi:10.1300/J084v17n03_01.
Age
Older
Older women are often not recognized as victims of sexual assault because the sequelae of sexual assault are thought to be a normal aspect of ageingxvii
Sexual assault is the only violent crime for which older women have higher rates of victimization than men in Canadaxviii
Older victims may exhibit trauma symptoms, such asxix:
Fear of the assault location
Fear of males and male caregivers if sexually assaulted in a nursing home
Flashbacks
Confusion, lack of appetite, withdrawal, insomnia, exacerbation of existing conditions
Compared to younger victims of sexual assault, older victims are more likely to live alonexxxxi and are less likely to report supportive relationshipsxxii which may contribute to their vulnerability
Sexual assault of older victims often takes place in the victim’s homexxiiixxivxxv
Bachman, R., Dillaway, H., & Lachs, M.S. (1998). Violence against the elderly. Research on Aging, 20, 183-199
Government of British Columbia. (2005). Abuse and Neglect of Older Adults: Understanding Gender Differences. BC Health Files
Burgess, A.W. & Morgenbesser, L.I. (2005). Sexual violence and seniors. Brief Treatment and Crisis Intervention, 5, 193-202.
Safarik, M.E., Jarvis, J.P., & Nussbaum, K.E. (2002). Sexual homicide of elderly females: Linking offender characteristics to victim and crime scene attributes. Journal of Interpersonal Violence, 17, 500-525.
Roberto, K.A. & Teaster, P.B. (2005). Sexual abuse of vulnerable young and old women. Violence Against Women, 11, 473-504.
Del Bove, G., Stermac, L., & Bainbridge, D. (2005). Comparisons of sexual assault among older and younger women. Journal of Elder Abuse & Neglect, 17(3), 1-18. doi:10.1300/J084v17n03_01.
Cartwright, P. & Moore, R.A. (1989). The elderly victim of rape. Southern Medical Journal, 82, 988-989.
Muram, D.,Miller, K., & Cutler, A. (1992). Sexual assault of the elderly victim. Journal of Interpersonal Violence, 7, 70-76.
Del Bove, G., Stermac, L., & Bainbridge, D. (2005). Comparisons of sexual assault among older and younger women. Journal of Elder Abuse & Neglect, 17(3), 1-18. doi:10.1300/J084v17n03_01.
Context
Drinking Alcohol
There are two common Drug Facilitated Sexual Assault (DFSA) scenariosxxvixxvii:
An assailant may ply the victim with alcohol and/or drugs OR may give her alcohol/drugs without her knowing (i.e. spike her drink
The victim may contribute to her incapacitation and vulnerability by consuming alcohol and/or drugs
Among women presenting to local Sexual Assault/Domestic Violence Treatment Centres in Ontario, Canadaxxviiixxix:
65% had consumed alcohol immediately prior to being sexually assaulted
Women may increase their vulnerability to sexual assault by consuming alcoholxxxxxxi
A perpetrator may intentionally incapacitate a woman by encouraging excessive drinking or plying them with alcoholxxxiixxxiii
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Context
Taking Illegal Drugs
There are two common Drug Facilitated Sexual Assault (DFSA) scenariosxxxivxxxv:
An assailant may ply the victim with alcohol and/or drugs OR give her alcohol/drugs without her knowledge (i.e. spike her drink)
The victim may contribute to their incapacitation and vulnerability by consuming alcohol and/or drugs
Among women presenting to local Sexual Assault/Domestic Violence Treatment Centres in Ontario, Canadaxxxvixxxvii:
21% had used street drugs in the 72 hours prior to the assault
Women may increase their vulnerability to sexual assault by consuming illegal drugsxxxviiixxxix
A perpetrator may intentionally incapacitate a woman by encouraging or forcing drug usexlxli
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Context
Mixing Alcohol & Drugs
There are two common Drug Facilitated Sexual Assault (DFSA) scenariosxliixliii:
An assailant may ply the victim with alcohol and/or drugs OR give her alcohol/drugs without her knowledge (i.e. spike her drink)
The victim may contribute to their incapacitation and vulnerability by consuming alcohol and/or drugs
Among women presenting to local Sexual Assault/Domestic Violence Treatment Centres in Ontario, Canadaxlivxlv:
65% had consumed alcohol immediately prior to being sexually assaulted
21% had used street drugs in the 72 hours prior to the assault
33% had used prescription drugs in the 72 hours prior to the assault
12% had used over-the-counter drugs in the 72 hours prior to the assault
Women may increase their vulnerability to sexual assault by consuming alcohol and drugs (including prescription, illegal, over-the-counter medications) without fully recognizing their additive impactxlvixlvii
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Context
Intentionally Drugged
There are two common Drug Facilitated Sexual Assault (DFSA) scenariosxlviiixlix:
An assailant may ply the victim with alcohol and/or drugs OR give her alcohol/drugs without her knowledge (i.e. spike her drink)
The victim may contribute to their incapacitation and vulnerability by consuming alcohol and/or drugs
Among women presenting to local Sexual Assault/Domestic Violence Treatment Centres in Ontario, Canadalli:
21% believe they were intentionally drugged, the majority through their drinks being spiked
59% were 16-24 years old
43% were students
46% were physically injured
Women who believed they were intentionally drugged (compared to those who did not) and sexually assaulted presenting to local Sexual Assault/Domestic Violence Treatment Centres in Ontario, Canada were also more likely toliiliii:
Be employed
Drink alcohol immediately before the assault
Use over-the-counter medication (i.e. cough syrup) within 72 hours prior to the assault
Use street drugs (i.e. marijuana, cocaine) within 72 hours prior to the assault
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Du Mont et al., (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513-519.
Du Mont et al., (2010). Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic and Legal Medicine, 17, 333-338.
Context
Walking Home and Other Activities
51% of students and 29% of non-students were sexually assaulted while travelling to/from leisure activities away from home
31 % of students and 50% of non-students were sexually assaulted while at home
10% of students and 16% of non-students were sexually assaulted while travelling to/from work
65% of students and 64% of non-students were sexually assaulted between the hours of 6pm and 6am
The majority of both student (95%) and nonstudent (92%) sexual assaults involved one perpetrator
Nonstudents (32%) were more likely than students (20%) to report the sexual assault to police
The majority of both student (83%) and nonstudent (82%) sexual assault victims did not receive assistance from a victim service agencyliv
Women who have been sexually assaulted may have a psychological, physical, cognitive or sensory disability. In some cases, women may have more than one disability.
Having a disability may increase a woman’s risk for sexual assaultlv
Women with severe disabilities are four times more likely to be sexually assaulted in the past year compared to women without disabilitieslvi
Women with disabilities may be more vulnerable to sexual assault due tolviilviii:
Dependence (abuser may be a caregiver)
Lack of access to support services
Unable to leave or call for help due to mobility, cognitive or communication impairments
Low self-esteem due to societal myths and social attitudes about persons with disabilities
Sexual assault may have a greater negative impact on the well-being of women with disabilities and further compromise their healthlix
Women who are assaulted at 30+ years of age are three times more likely to be disabled than younger womenlx
21% of women presenting to Sexual Assault/Domestic Violence Treatment Centres in Ontario, Canada had a disability
Among women with disabilities who were seen for sexual assault or domestic violence at a Sexual Assault/Domestic Violence Treatment Centre in Ontario, Canadalxi:
44% had a psychological disability
37% had a physical disability
20% had a cognitive disability
4% had a sensory disability
17% did not specify the type of disability
21% reported having multiple disabilities
Less likely to be accompanied
More likely to be homeless or living in a shelter
More likely to sustain physical injuries
DAWN Ontario, Disabled Women’s Network Ontario, 2006
Martin et al., 2006. Physical and sexual assault of women with disabilities. Violence Against Women, 12(9), 823-837.
Martin et al., 2006. Physical and sexual assault of women with disabilities. Violence Against Women, 12(9), 823-837.
Tyiska, 1998
Nannini A. Sexual assault patterns among women with and without disabilities seeking survivor services. Womens Health Issues 2006;16(6):372-9
Du Mont, J., White, M., Macdonald, S., & Turner, L. (YEAR). Are abused adolescent and adult women with disabilities satisfied with sexual assault and domestic violence treatment services in Ontario? Poster presented at XX.
Social Support
Good Social Suppot
Among women who have been sexually assaulted, social support has been associated with less psychological distresslxiilxiiilxivlxvlxvilxviilxviii and better physical healthlxixlxx
Sexual assault victims indicate that positive support from healthcare providers may be especially important when it:
Supportive and non-judgmental reactions to disclosures of sexual assault are important a woman’s recovery as they:
Validate her experience
Allow her to work through her feelings
May enhance her ability to find meaning in the experiencelxxiiilxxiv
Atkeson et al., 1982
Campbell et al., 2001
Ullman, 1996a
Ullman, 1996b
Ullman, S. (1999). Social support and recovery from sexual assault: A review. Aggression and Violence Behavior, 4(3), 343-358
Burgess & Holmstrom, 1978
Testa et al., 1992
Kimerling & Calhoun, 1994
Kimerling & Calhoun, 1994
Ullman, S. (1999). Social support and recovery from sexual assault: A review. Aggression and Violence Behavior, 4(3), 343-358.
Lanthier, S., Du Mont, J., & Mason, R. (unpublished). Improving health care providers’ responses to non-acute adolescent and adult female sexual assault survivors: A systematic review of best practices in responding to delayed disclosure in health settings.
Ullman, S. (1999). Social support and recovery from sexual assault: A review. Aggression and Violence Behavior, 4(3), 343-358.
Lanthier, S., Du Mont, J., & Mason, R. (unpublished). Improving health care providers’ responses to non-acute adolescent and adult female sexual assault survivors: A systematic review of best practices in responding to delayed disclosure in health settings.
Social Support
Poor Social Support
Victims of sexual assault are likely to have fewer sources of social support than non-victimslxxv
Victims of sexual assault are less likely to:
Be married
Have weekly contact with friends and relatives
Receive less emotional support from friends and familylxxvi
Women with disabilities who experience sexual assault were less likely to be accompanied by a friend/family member to a Sexual Assault and Domestic Violence Treatment Centre than those without a disabilitylxxvii
Some research suggests that women who receive less positive support in the form of emotional support and information may be more susceptible to being re-sexually assaultedlxxviiilxxix
Negative social reactions to disclosure of sexual assault, such as disbelieving, blaming, minimizing, as well as rejection and lack of support from one’s community, friends, and family, may result in additional harm or ‘secondary victimization’lxxxlxxxilxxxii
Golding, Wilsnack, & Cooper, 2002
Golding, J.M., Wilsnack, S.C., & Cooper, M.L. (2002). Sexual assault history and social support: Six general population studies. Journal of Traumatic Stress, 15(3), 187-197.
Du Mont, J., White, M., Macdonald, S., & Turner, L. (YEAR). Are abused adolescent and adult women with disabilities satisfied with sexual assault and domestic violence treatment services in Ontario? Poster presented at XX.
Golding, J.M., Wilsnack, S.C., & Cooper, M.L. (2002). Sexual assault history and social support: Six general population studies. Journal of Traumatic Stress, 15(3), 187-197.
Gillian E. Mason, Sarah Ullman, Susan E. Long, LaDonna Long, and Laura Starzynski
Lanthier, S., Du Mont, J., & Mason, R. (unpublished). Improving health care providers’ responses to non-acute adolescent and adult female sexual assault survivors: A systematic review of best practices in responding to delayed disclosure in health settings.
Davis et al., 1991
Symonds, 1980
Sequelae
Physical
Some women may be affected by sexual assault for a long time whereas others may recover more quickly. Reactions and ability to cope may fluctuate and change over time and in response to other life events.
Common physical sequelae of sexual assault includelxxxiii:
Damage to the urethra, vagina and anus
Increased risk of contracting sexually transmissible infections, including HIV/AIDS
Unwanted pregnancy and decisions regarding abortion
Gynaecologic symptoms and problems associated with sex
Sexual and reproductive health problems
Pelvic pain
Gastrointestinal health problems
Pain syndromes and eating disturbances/disorders, especially bulimia nervosa
Some women may be affected by sexual assault for a long time whereas others may recover more quickly. Reactions and ability to cope may fluctuate and change over time and in response to other life events.
Common psychological or emotional sequelae of sexual assault includelxxxiv: