Handbook of Women, Stress and Trauma

Kathleen A. Kendall-Tackett

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780415947428
• eBook ISBN: 9781135401436
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

The Handbook of Women, Stress and Trauma focuses on the stresses and traumas that are unique to the lives of women. It is the first text to merge research from the fields of trauma and women's health and development. Using a lifespan developmental approach, the text begins by addressing specific issues women face in their lives, drawing upon theories of development and exploring how women's relationships with others buffer - or sometimes cause - stress and trauma. Combining aspects of female development with empirical data from the fields of women's health, family violence and stress and coping, this volume helps sensitive care providers to the specific needs of women exposed to traumatic events.

Section II

THE SPECTER OF VIOLENCE
AGAINST WOMEN

5

Sexual Violence in the Lives of Girls and Women

KATHLEEN C. BASILE

1 OVERVIEW AND DEFINITION OF THE PROBLEM

Sexual violence is a serious social and public health problem in the United States. Evidence from decades of research has shown that women are at risk for sexual violence throughout their life span. While sexual violence is commonly conceived of as rape, defined as completed or attempted penetration of some sort, sexual violence is much broader and more encompassing than rape. Sexual violence comes in many forms—some that involve physical contact and some that do not. In a recent report, the Centers for Disease Control and Prevention defined sexual violence as completed or attempted penetration of the genital opening or anus by the penis, a hand, a finger, or any other object; penetration of the mouth by the penis or other object; abusive sexual contact without penetration, such as intentional touching of the groin; or noncon-tact sexual abuse, such as acts of voyeurism (peeping Tom) or sexual harassment (Basile & Saltzman, 2002).

Sexual violence also includes acts such as systematic rape during times of war, sexual trafficking (the buying and selling of girls and women into prostitution and sexual slavery), and female genital mutilation (see Jewkes, Sen, & Garcia-Moreno, 2002, for a review of sexual violence in a global context). Critical to the definition, sexual violence occurs when the survivor does not consent to the sexual activity or when the survivor is unable to consent (e.g., due to age or illness) or unable to refuse (e.g., due to physical violence or threats) (Basile & Saltzman, 2002).

2 PUBLIC HEALTH APPROACH TO SEXUAL VIOLENCE

Public health refers to “what society does to assure that conditions exist in which people can be healthy” (McMahon, 2000, p. 28). Sexual violence should be considered a public health concern for a variety of reasons. First, as will be described in the next section, sexual victimization is a widespread problem that starts early in life and, for many survivors, is repeated over the life span. Second, the consequences of sexual violence are health related. A public health approach treats all forms of violence as health issues, because there are quantifiable physical and psychological injuries that result from them (Mercy, Rosenberg, Powell, Broome, & Roper, 1993). Third, implicit in the public health focus is the idea that public health problems are preventable, and more emphasis should be placed on the front end before a problem begins or becomes widespread. This chapter concludes with more discussion about how the public health approach can be applied to the prevention of sexual violence.

3 MAGNITUDE OF THE PROBLEM

There have been numerous criticisms of official crime statistics, such as the Uniform Crime Reports (UCR) and the National Crime Victimization Survey (NCVS), for their inabilities to capture the true extent of sexual violence victimization (Russell, 1984; Koss, 1992, 1996; Kilpatrick, 2002). The UCR present data on forcible rape and attempted rape reported to and compiled by participating law enforcement agencies and sent to the Federal Bureau of Investigation (FBI) (Kilpatrick, 2002). A major concern of the UCR is that it does not capture people who do not report to the police, and these people include the majority of rape survivors (Kilpatrick, Edmunds, & Seymour, 1992).

The NCVS is a nationwide survey of households in the United States. It is designed to detect both reported and unreported crimes. A weakness of this official survey is that it uses the term “rape” in its questions, which many critics have warned against using due to the stigma associated with this word and the likelihood that respondents would not define their experiences as rape, particularly if the perpetrator was someone they knew (Koss, 1988; Belknap, Fisher, & Cullen, 1999). Further, the NCVS is a crime survey. Critics have pointed out the benefits of including sexual violence items on noncrime surveys, due to the likelihood of obtaining a low response rate in the context of a crime survey if respondents do not consider their experiences with unwanted sex to be crimes (Koss, 1992). Although the NCVS has recently been revised to address some of the critics' concerns (Bachman & Saltzman, 1995), it still has weaknesses. Many sexual violence researchers argue for the use of self-report noncrime surveys that include several questions about specific behaviors, to facilitate recall and guard against underreporting (Russell, 1984; Koss, 1992, 1993; DeKeseredy, 1995; Belknap et al., 1999). For these reasons, this chapter does not cover the official sources of sexual violence statistics, such as the UCR and the NCVS, but focuses, rather, on self-report surveys that have used behaviorally specific measures.

3.1 Prevalence of Sexual Violence

Most of the prevalence studies of sexual violence use behaviorally specific measures of rape only, as opposed to a broader focus on sexual violence. For these reasons, most of what will be discussed here is rates of rape. According to the National Violence Against Women Survey (NVAWS), an estimated one in six women have experienced an attempted or completed rape at some point in their lifetimes. In 8 out of 10 cases (83%), someone the survivor knew perpetrated the rape (Tjaden & Thoennes, 2000), and 62% of rapists of adult women are intimate partners defined in the NVAWS as current or former spouses, cohabitating partners, boyfriends, or dates, followed by acquaintances (21%), strangers (17%), and other relatives (7%) (Tjaden & Thoennes, 2000).

In the National Women's Study (NWS), intimate partners (current or former spouses or boyfriends) represented 19% of perpetrators; family members represented 27% of perpetrators; strangers represented 22% of perpetrators; and the largest percentage of perpetrators, 29%, included other nonrelatives, such as friends or acquaintances (Kilpatrick et al., 1992). The large majority of survivors of rape and other sexual violence are female, and data show that most perpetrators are male (Tjaden & Thoennes, 2000). Therefore, sexual violence can be characterized as a form of gender-based violence.

3.2 Rape and College-Age Women

Several researchers studied rape experiences among college-age women. Koss and colleagues conducted one of the earliest nationally representative self-report studies of rape and other forms of sexual violence, and they found that approximately one in four college women (27%) had survived rape (15%) or attempted rape (12%) in their lifetimes (Koss, Gidycz, & Wisniewski, 1987). In addition, this study revealed that 14% of women experienced unwanted sexual contact (e.g., fondling, kissing, or petting after continual arguments and pressure, or misuse of authority); and 12% of women experienced sexual coercion (e.g., penetrative sex after continual arguments and pressure or misuse of authority).

Since this groundbreaking work, more recent studies of college women revealed similar rape rates. In the National College Health Risk Behavior Survey (NCHRBS) by Brener, McMahon, Warren, and Douglas (1999), one in five women (20%) in a nationally representative sample reported that they experienced a completed rape at some point in their lives. Researchers also identified that the college years in particular are vulnerable times for women. In Koss's and colleagues' (1987) study, the authors found that 83 per 1,000 women in their sample experienced attempted or completed rape during a 6-month period while they were in college. More recently, the National College Women Sexual Victimization Study estimated that between one in four and one in five college women are raped during their college years (Fisher, Cullen, & Turner, 2000).

Several U.S. surveys, including the NVAWS, the NWS, and the NCHRBS, revealed that most survivors of rape were young when the first rape occurred. For example, the NCHRBS found that for 71% of survivors, the first rape occurred before the age of 18 (Brener et al., 1999). The NVAWS found that 54% of all first rapes of women occurred before the age of 18, and almost half of these occurred before age 12 (Tjaden & Thoennes, 2000). Similarly, in the NWS, 62% of all rapes occurred before age 18, and 29% occurred before age 12 (Kilpatrick et al., 1992). In light of these findings, rape has been called a problem of youth (Tjaden & Thoennes, 2000; Kilpatrick et al., 1992).

3.3 Child Sexual Abuse

However, child sexual abuse appears to be an even larger problem than rape. Child sexual abuse commonly includes other types of sexual violence, such as fondling, exhibitionism (exposing oneself), and manual stimulation of the perpetrator. It requires different items to assess than are used in rape screening (Koss, Bailey, Yuan, Herrera, & Lichter, 2003). A synthesis of findings from 16 studies on the prevalence of child sexual abuse estimated that 22% of U.S. women were sexually abused in childhood (Gorey & Leslie, 1997).

3.4 Elder Sexual Abuse

Less is known about sexual violence perpetrated against the elderly (usually defined as 60 years or older), but elder abuse has been getting more attention as a serious problem in the United States and all over the world in recent years, as the elderly population has expanded (Wolf, Daichman, & Bennett, 2002). Findings from the National Elder Abuse Incident Study (NEAIS, 1998) revealed that in 1996, 3% of all nationwide reports of elder (defined here as 50 years or older) abuse were incidents of sexual violence (NEAIS, 1998). This figure is an underestimate, because it does not reflect unreported cases of elder sexual violence. Much of what we know about the characteristics of sexual violence among the elderly comes from studies of nursing homes. In their study of 20 nursing home residents (18 women, 2 men) who experienced sexual violence, Burgess, Dowdell, and Prentky (2000) found that most residents had a preexisting cognitive deficit (e.g., Alzheimer's disease) that made them more vulnerable and made communicating the incident challenging. Muram, Miller, and Cutler (1992), comparing elder rape survivors with younger rape survivors receiving care at a treatment clinic, found that elder survivors were more likely than younger survivors to have been assaulted at home by a stranger. These studies suggest the need for a more comprehensive examination of this vulnerable subgroup of sexual violence survivors.

3.5 Difficulty in Estimating the Problem

Rape is one of the most underreported crimes, which makes it difficult to count (Bachar & Koss, 2001). The NWS (Kilpatrick et al., 1992) found that 84% of women in their sample did not report their rapes to the police. Reasons for underreporting are numerous. A significant reason appears to be cultural norms that stigmatize and blame women for their assaults. People who survive armed robbery or terrorist attacks are not held responsible for the incident. Rather, they are usually given sympathy. Rape survivors, on the other hand, are often perceived to play some role in their assaults. For instance, women who experience rape still encounter disbelief about the details of the incident by police and physicians (Ullman, 1996a), and they can be blamed for the rape because of what they were wearing at the time of the rape or because they had been drinking alcohol (Campbell et al., 1999). Research has documented several myths about the circumstances of rape that large segments of Americans widely endorse (Lonsway & Fitzgerald, 1994). Some of the most prevalent rape myths are that women lead men on and, therefore, deserve to be raped; women often make false accusations of rape; no woman can be raped against her will; and most rapists are strangers (Brownmiller, 1975; Burt, 1980; Ward, 1995). In such a society, rape survivors often do not disclose experiences of rape and other sexual violence.

A major contributing factor to nondisclosure of rape is its intimate nature. Because most perpetrators of rape and other sexual violence are known to the survivor (e.g., friends, family members, boyfriends, coworkers, marital partners), survivors are even more likely to be perceived as at least partially responsible for the rape (Monson, Byrd, & Langhinrichsen-Rohling, 1996; Monson, Langhinrichsen-Rohling, & Binderup, 2000). Women violated by their husbands, in particular, are given the least amount of sympathy, based in part on cultural beliefs about marriage and a history of laws that have treated the marriage license as a “license to rape” (Finkelhor & Yllo, 1985). This intimate context perpetuates an environment in which rape and other sexual violence are often shameful for survivors and are kept secret.

4 VULNERABILITY FACTORS FOR SEXUAL VIOLENCE

Researchers have examined factors that increase women's vulnerability to victimization. Vulnerability research seeks to uncover factors that may increase the likelihood for rape, and it is distinct from victim blaming, which mistakenly assigns responsibility for victimization to survivors. One common vulnerability factor for adult rape is a previous history of child sexual abuse. Child sexual abuse survivors are three to five times more likely to be raped as adults than respondents who did not experience any type of child abuse (Maker, Kemmelmeier, & Peterson, 2001; Merrill et al., 1999; West, Williams, & Siegel, 2000).

In addition, poverty and homelessness can increase women's and children's vulnerability to rape and other forms of sexual violence, because it makes their daily lives more dangerous (e.g., walking alone at night, less parental supervision of children) (Jewkes et al., 2002). Poverty may also force women and girls into high-risk occupations, such as sex work (e.g., prostitution), which has been associated with sexual victimization (Irwin et al. 1995).

4.1 Substance Abuse and Rape

Researchers have examined the relationships between substance abuse and victimization. Regarding alcohol use, results are mixed. Greene and Navarro (1998) found that excessive alcohol use predicted subsequent sexual victimization among a sample of college women. However, Brecklin and Ullman (2002) found that neither alcohol use by the survivor at the time of the incident nor alcohol consumption in the last 12 months was associated with increased risk of rape. Further, in the largest U.S. longitudinal study to date, recreational drug use, but not alcohol consumption, was found to increase the likelihood of rape (Kilpatrick, Acierno, Resnick, Saunders, & Best, 1997). Some have pointed out that in cases of sexual violence, alcohol and other drugs may serve as cues to the perpetrator. For example, men may perceive women who drink alcohol as “easy,” or more interested in sex (Koss et al., 1994; Abbey, Zawacki, Buck, Clinton, & McAuslan, 2001). Drinking alcohol and taking drugs may also put women in settings where encountering a pot...

Table of contents

• Front Cover
• Half Title
• BRUNNER-ROUTLEDGE PSYCHOSOCIAL STRESS SERIES
• Title Page
• Copyright
• Contents
• Contributors
• Series Editor's Foreword
• Acknowledgments
• Introduction: Women's Experiences of Stress and Trauma
• SECTION I: WOMEN'S STRESS AND TRAUMA IN LIFE-SPAN PERSPECTIVE
• SECTION II: THE SPECTER OF VIOLENCE AGAINST WOMEN
• SECTION III: STRESS AND TRAUMA IN THE LIVES OF WOMEN OF COLOR, WOMEN WITH DISABILITIES, AND LESBIAN WOMEN
• Index