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A neglected class of sexual assault victims consists of women who were molested as children. In response to their unmet needs, therapy groups composed solely of women who were sexually abused in their childhood have been established. The goals of these groups are twofold: (1) the alleviation of sexual guilt and shame and (2) the clarification of emotional and behavioral consequences of molestation. Ten groups have been conducted, each containing four to six members, comprising an overall total of 50 women. In 97% of the cases, a prior relationship had existed between perpetrator and victim. Treatment consisted of a four-session format. During session I, each group participant described her molestation experiences in detail. Sessions II and III focused on how these experiences have affected the women. Session IV dealt with individual stages of recovery and further treatment plans. Clinical findings included feelings of guilt and depression, negative self-image, and problems in interpersonal relationships associated with an underlying mistrust of men, inadequate social skills, and difficulties in sexual functioning. Evaluations of the therapy groups by the participants indicated that the primary curative component was the sense of identification and emotional closeness instilled by a warm and supportive environment where a common bond was shared.
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PMID:Therapy groups for women sexually molested as children. 56 22

Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.
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PMID:Cognitive processing therapy for sexual assault victims. 140 90

Of 63 sexual assault victims who were a mean 7.9 years postevent, almost two thirds (60%, n = 38) demonstrated some degree of depression. Over half (56%, n = 35) the sample also reported a history of childhood sexual abuse. Three factors had a significant positive association with higher levels of depression: nondisclosure of the assault to significant others due to concerns about stigma; the presence of children living with the victim; and a civil lawsuit pending. One factor, currently being sexually active, had a significant negative association with depression. Results are discussed from the perspective of depression, a common pathway by which unresolved sexual trauma is expressed.
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PMID:Factors associated with long-term depressive symptoms of sexual assault victims. 156 43

Sexual assault of women in the United States may have a prevalence rate of 25% or more. Moreover, the majority of survivors of sexual assault know their assailants. Consequences of assault may be severe and long-term, including fear and anxiety, depression, suicide attempts, difficulties with daily functioning and interpersonal relationships, sexual dysfunction, and a whole range of somatic complaints. Recent evidence implicates societal factors, such as acceptance of rape myths, rigid sex role stereotyping beliefs, and acceptance of violence as a legitimate means for obtaining compliance in interpersonal relationships, in the etiology of sexual violence against women. I present a model for primary, secondary, and tertiary prevention of rape. Primary prevention represents a program of anticipatory guidance in a developmental framework. Secondary prevention entails identification of and early intervention in dysfunctional families. Tertiary prevention consists of the appropriate treatment of the survivor of sexual assault to prevent or minimize subsequent physical and psychological problems. This preventive framework may be incorporated into the practice of clinical preventive medicine and primary care.
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PMID:Sexual violence against women: prevalence, consequences, societal factors, and prevention. 179 44

Several multivariate studies have attempted to delineate the major predictors of long-term, sexual assault-induced aftereffects. The present study was an attempt to extend previous work by supplementing known preassault, assault, and postassault predictors of trauma with cognitive measures. The data were cross-sectional and included responses from 1,213 victims of sexual assault who were recruited from a national sample of higher education students. Utilizing hierarchical multiple regression analyses and a cross-validation procedure, the results suggested that the prior mental status of the victims, the forcefulness of the assaults, as well as two cognitive variables related to a victim's beliefs about sex and relationships predicted victims' scores on standardized measures of anxiety and depression. The relationships were such that the most traumatized victims were those women who had evidenced a history of mental health problems, who had experienced the more aggressive assaults, who tended to believe that people in relationships are not trustworthy, and tended to place conservative restrictions on the sexual acts and circumstances under which sex should occur. Taken together these variables accounted for between 9%-14% of the variance in sexual assault aftereffects. The discussion emphasizes the contribution of cognitive processes to the understanding of sexual assault trauma.
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PMID:Predictors of long-term sexual assault trauma among a national sample of victimized college women. 181 16

Sexual assault as a major psychological trauma and a crime of violence evokes immediate symptoms of posttraumatic stress and, for many victims, long-term posttraumatic psychological sequelae. The victim, as the recipient of the rapist's anger and need to control, experiences terror, fear of death, and helplessness. This results in classic posttraumatic symptoms of haunting, intrusive recollections, numbing or constriction of feelings and focus, and increased arousal. When this psychological trauma is not integrated, anxiety, depression, phobias, impaired sexual and social adjustment, negative self-image, and diminished capacity to enjoy life follow. Concepts of posttraumatic stress are reviewed and a definition of sexual assault is offered. The posttraumatic stress response to sexual assault is considered under the phases of response and symptoms, followed by the psychodynamics of this particular psychic trauma. A brief overview of treatment is outlined.
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PMID:Posttraumatic stress disorder after sexual assault: its psychodynamics and treatment. 193 84

Sexual assault, as a crime of violence, induces a life crisis which inflicts major psychological and physiological trauma upon the victim. Lack of mutual consent is present in all sexual assaults. Post-traumatic symptoms occur immediately and for a large percentage of victims this trauma is not integrated for many years. Symptoms include the classic triad of post-traumatic stress symptoms of haunting, intrusive recollections, numbing or constriction of feelings and focus and lowered threshold of anxious arousal subsequent to experiencing intense fear, terror and loss of control. Long term effects include anxiety, depression, phobic reactions to situations reminiscent of the sexual assault, sexual dysfunction, impaired social adjustment and diminished capacity to enjoy life. Post-traumatic stress responses, symptomatology, psychodynamics and management of the victim of recent and nonrecent sexual assault are reviewed.
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PMID:Psychological management of victims of sexual assault. 218 May 47

Development of a measure of child sexual abuse, operationalized as unwanted sexual contact before age 17, is described. In a community mental health survey of 750 women aged 18 to 27 yr., 32% recalled unwanted sexual contact. 7% experienced prolonged sexual assault before age 17 and had significantly higher scores as adults on the CESD Depression scale.
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PMID:Development of a measure of unwanted sexual contact in childhood, for use in community mental health surveys. 234 25

The incidence of sexual abuse in eating disorder patients appears significant. Fifty percent of both our anorectic and bulimic patients reported a history of sexual abuse while only 28% of a non-anorexic, non-bulimic control population reported similar problems (p less than 0.01). Several patterns of behavior seemed related to previous sexual assault. In one, the eating disorder was used to change the body image of the patient and therefore to provide a defense to future abuse. Other behaviors which occurred more specifically in bulimic women dealt with a projection of repressed anger toward male authority figures. Forty six percent of the bulimic women seen in our study exhibited some promiscuous behavior, using sex either as a gauge of their own self worth or as a means of punishing men. It is essential that sexual issues be addressed early in the treatment of patients with eating disorders. Disclosure is often difficult particularly in outpatient situations where the patient lives at home with her family. It usually does not occur in such cases until the later stages of therapy, or until the patient is hospitalized. Rape is the exception since our data suggests that it is usually revealed early in the course of treatment (p less than 0.001). Once disclosure occurs, a dramatic change is usually seen in the patient and treatment becomes more effective. As the patient deals with the issues of sexual abuse, they no longer need to deny their sexuality or punish themselves or others. Issues of guilt, depression, repressed anger, low self-esteem, social isolation and inadequacy are important and need to be addressed during the course of therapy with sexually abused patients.
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PMID:Sexual abuse in patients with eating disorders. 260 70

This paper reviews the literature on childhood sexual abuse and its implications for women. It is estimated that at least 15-38% of adults have been sexually abused as children, with figures higher for women than for men. Failure to report abuse is common, and only 20-50% of incidents may come to the attention of authorities. Although childhood sexual abuse is present in all socioeconomic groups, more severe forms of abuse appear to be associated with lower socioeconomic status. After the age of ten, a sharp increase is observed in vaginal intercourse, sexual assaults accompanied by physical violence, and abuse committed by strangers. Although fathers are frequently cited as the primary perpetrators, not all studies support this finding. Other relatives have been reported to account for 20-70% of the sexual abuse occurring within the family. A history of childhood abuse may contribute to sexual problems or multiple chronic complaints in the adult woman. Moreover, some of these women may experience depression, anxiety, and low self-esteem. The gynecologist should use empathetic questioning with all patients regarding abuse, and integrate the patient's history of abuse with current health care. Physicians who are uncomfortable with this topic or who observe ongoing distress in their patients should refer these women to a mental health practitioner who is familiar with the issues common to women who have experienced childhood sexual abuse.
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PMID:Childhood sexual abuse and the consequences in adult women. 328 Oct 78


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