Beyond the Force–Substance Dichotomy: Examining the Experience of Combined and Incapacitated Type Rapes and Their Relation to PTSD Symptoms

Abstract

Prior research has examined how posttraumatic stress disorder (PTSD) symptoms are influenced by the experience of different types of rape, defined according to the method of coercion used. This work, which classifies rape experiences as either forcible or substance-involved, has yielded mixed findings regarding differences in PTSD symptoms as a function of rape type. Based on recent evidence indicating significant heterogeneity within substance-involved rapes, the present study utilized a novel four-group conceptualization of rape type to examine differences in PTSD symptom severity and associated factors across rape type. Using a sample of 161 community women with experiences of adult rape, we examined four rape types based on method of coercion: forcible-only rape (i.e., involving only force/threat of force; n = 48), impaired rape (i.e., substance-related impairment was present, but the participant remained conscious; n = 56), combined rape (i.e., both force/threat of force and substance-related impairment were present; n = 29), and incapacitated rape (i.e., the participant was intoxicated to the point of unconsciousness; n = 28). We compared these groups on PTSD symptom severity within each symptom cluster, as well as on assault characteristics and consequences, including peritraumatic fear and injury, acknowledgment, and self-blame. Combined type rapes were associated with significantly more severe PTSD symptoms than forcible-only and impaired type rapes. Differences among the groups were also found for peritraumatic fear and injury, and rape acknowledgment. Utilizing a dichotomous approach to rape type overlooks the complexity of women’s experiences. Differences in PTSD symptom severity as a function of the proposed four-group conceptualization of rape type highlight the importance of assessing method of coercion when treating rape-related PTSD. Likewise, differences across rape types in peritraumatic fear and rape acknowledgment highlight the potential utility of type-specific targets of intervention.

Keywords

sexual assault alcohol and drugs PTSD adult victims

Get full access to this article

View all access options for this article.

References

Abbey

BeShears

Clinton-Sherrod

A. M.

McAuslan

(2004). Similarities and differences in women’s sexual assault experiences based on tactics used by perpetrator. Psychology of Women Quarterly, 28, 323-332.

Abbey

Zawacki

Buck

P. O.

Clinton

A. M.

McAuslan

(2004). Sexual assault and alcohol consumption: What do we know about their relationship and what types of research are still needed? Aggression and Violent Behavior, 9, 271-303.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Blanchard

E. B.

Jones-Alexander

Buckley

T. C.

Forneris

C. A.

(1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669-673.

Bownes

I. T.

O’Gorman

E. C.

Sayers

(1991). Assault characteristics and posttraumatic stress disorder in rape victims. Acta Psychiatrica Scandinavica, 83, 27-30.

Breslau

Kessler

R. C.

Chilcoat

H. D.

Schultz

L. R.

Davis

G. C.

Andreski

(1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry, 55, 626-632.

Brewin

C. R.

Andrews

Rose

(2000). Fear, helplessness, and horror in posttraumatic stress disorder: Investigating DSM-IV Criterion A2 in victims of violent crime. Journal of Traumatic Stress, 13, 499-509.

Brewin

C. R.

Dalgleish

Joseph

(1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103, 670-686.

10.

Brown

A. L.

Testa

Messman-Moore

T. L.

(2009). Psychological consequences of sexual victimization resulting from force, incapacitation, or verbal coercion. Violence Against Women, 15, 898-919.

11.

Bryant

R. A.

(2001). Posttraumatic stress disorder and traumatic brain injury: Can they co-exist? Clinical Psychology Review, 21, 931-948.

12.

Dewey

Schuldberg

Madathil

(2014). Do peritraumatic emotions differentially predict PTSD symptom clusters? Initial evidence for emotion specificity. Psychological Reports, 115, 1-12.

13.

Dunn

O. J.

(1964). Multiple comparisons using rank sums. Technometrics, 6, 241-252.

14.

Ehlers

Clark

D. M.

(2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.

15.

Faravelli

Giugni

Salvatori

Ricca

(2004). Psychopathology after rape. American Journal of Psychiatry, 161, 1483-1485.

16.

Glaesser

Neuner

Lütgehetmann

Schmidt

Elbert

(2004). Posttraumatic stress disorder in patients with traumatic brain injury. BMC Psychiatry, 4, Article 5.

17.

Griffin

M. J.

Read

J. P.

(2012). Prospective effects of method of coercion in sexual victimization across the first college year. Journal of Interpersonal Violence, 27, 2503-2524.

18.

Hathaway

L. M.

Boals

Banks

J. B.

(2010). PTSD symptoms and dominant emotional response to a traumatic event: An examination of DSM-IV Criterion A2. Anxiety, Stress, & Coping, 23, 119-126.

19.

Kaysen

D. L.

Lindgren

K. P.

Lee

C. M.

Lewis

M. A.

Fossos

Atkins

D. C.

(2010). Alcohol-involved assault and the course of PTSD in female crime victims. Journal of Traumatic Stress, 23, 523-527.

20.

Kessler

R. C.

Sonnega

Bromet

Hughes

Nelson

C. B.

(1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.

21.

Kline

R. B.

(1998). Principles and practice of structural equation modeling. New York, NY: Guilford Press.

22.

Koss

M. P.

Gidycz

C. A.

Wisniewski

(1987). The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. Journal of Consulting and Clinical Psychology, 55, 162-170.

23.

Lawyer

Resnick

Bakanic

Burkett

Kilpatrick

(2010). Forcible, drug-facilitated, and incapacitated rape and sexual assault among undergraduate women. Journal of American College Health, 58, 453-460.

24.

Layman

M. J.

Gidycz

C. A.

Lynn

S. J.

(1996). Unacknowledged versus acknowledged rape victims: Situational factors and posttraumatic stress. Journal of Abnormal Psychology, 105, 124-131.

25.

Littleton

H. L.

Grills-Taquechel

Axsom

(2009). Impaired and incapacitated rape victims: Assault characteristics and post-assault experiences. Violence and Victims, 24, 439-457.

26.

Littleton

H. L.

Rhatigan

D. L.

Axsom

(2007). Unacknowledged rape: How much do we know about the hidden rape victim? Journal of Aggression, Maltreatment & Trauma, 14, 57-74.

27.

Littleton

H. L.

Tabernik

Canales

E. J.

Backstrom

(2009). Risky situation or harmless fun? A qualitative examination of college women’s bad hook-up and rape scripts. Sex Roles, 60, 793-804.

28.

Mohler-Kuo

Dowdall

G. W.

Koss

M. P.

Wechsler

(2004). Correlates of rape while intoxicated in a national sample of college women. Journal of Studies on Alcohol, 65, 37-45.

29.

Peter-Hagene

L. C.

Ullman

S. E.

(2015). Sexual assault-characteristics effects on PTSD and psychosocial mediators: A cluster-analysis approach to sexual assault types. Psychological Trauma: Theory, Research, Practice, and Policy, 7, 162-170.

30.

Redden

(2016, April 27). Oklahoma court: Oral sex is not rape if victim is unconscious from drinking. The Guardian. Retrieved from https://www.theguardian.com/society/2016/apr/27/oral-sex-rape-ruling-tulsa-oklahoma-alcohol-consent

31.

Rizvi

S. L.

Kaysen

Gutner

C. A.

Griffin

M. G.

Resick

P. A.

(2008). Beyond fear: The role of peritraumatic responses in posttraumatic stress and depressive symptoms among female crime victims. Journal of Interpersonal Violence, 23, 853-868.

32.

Roberts

A. L.

Rosario

Corliss

H. L.

Koenen

K. C.

Austin

S. B.

(2012). Elevated risk of posttraumatic stress in sexual minority youths: Mediation by childhood abuse and gender nonconformity. American Journal of Public Health, 102, 1587-1593.

33.

Ryan

K. M.

(1988). Rape and seduction scripts. Psychology of Women Quarterly, 12, 237-245.

34.

Sinozich

Langton

(2014). Rape and sexual assault victimization among college-age females, 1995-2013 (Report NCJ248471). Washington, DC: U.S. Department of Justice.

35.

Stack

(2016, June 6). Light sentence for Brock Turner in Stanford rape case draws outrage. The New York Times. Retrieved from http://www.nytimes.com/2016/06/07/us/outrage-in-stanford-rape-case-over-dueling-statements-of-victim-and-attackers-father.html

36.

Ullman

S. E.

Najdowski

C. J.

(2010). Understanding alcohol-related sexual assaults: Characteristics and consequences. Violence and Victims, 25, 29-44.

37.

U.S. Department of Justice. (2012). Revised rape definition announced for Uniform Crime Reporting program [Press release]. Retrieved from https://www.justice.gov/opa/pr/attorney-general-eric-holder-announces-revisions-uniform-crime-report-s-definition-rape

38.

Walsh

Danielson

C. K.

McCauley

J. L.

Saunders

B. E.

Kilpatrick

D. G.

Resnick

H. S.

(2012). National prevalence of posttraumatic stress disorder among sexually revictimized adolescent, college, and adult household-residing women. Archives of General Psychiatry, 69, 935-942.

39.

Walsh

Messman-Moore

Zerubavel

Chandley

R. B.

Denardi

K. A.

Walker

D. P.

(2013). Perceived sexual control, sex-related alcohol expectancies and behavior predict substance-related sexual revictimization. Child Abuse & Neglect, 37, 353-359.

40.

Weathers

F. W.

Litz

B. T.

Herman

Huska

Keane

(1994). The PTSD checklist–civilian version (PCL-C). Boston, MA: National Center for PTSD.

41.

White

A. M.

(2003). What happened? Alcohol, memory blackouts, and the brain. Alcohol Research & Health, 27, 186-196.

42.

Zinzow

H. M.

Resnick

H. S.

Amstadter

A. B.

McCauley

J. L.

Ruggiero

K. J.

Kilpatrick

D. G.

(2010). Drug- or alcohol-facilitated, incapacitated, and forcible rape in relationship to mental health among a national sample of women. Journal of Interpersonal Violence, 25, 2217-2236.

43.

Zinzow

H. M.

Resnick

H. S.

McCauley

J. L.

Amstadter

A. B.

Ruggiero

K. J.

Kilpatrick

D. G.

(2012). Prevalence and risk of psychiatric disorders as a function of variant rape histories: Results from a national survey of women. Social Psychiatry & Psychiatric Epidemiology, 47, 893-902.