The definition of rape has evolved over the past 30 years, largely in response to statutory rape reforms. Federal and state governments currently use definitions of rape that capture different types and contexts of sexual victimization. Most jurisdictions define rape as nonconsensual completed or attempted intercourse involving vaginal or anal penetration by a penis, hands, fingers, or foreign object or oral penetration by a penis with the use of force or threat of force or when the victim is unable to provide consent due to age, intoxication, or other factor. Many states have also established statutes criminalizing other physical and verbal sexual acts. The term sexual assault often refers to the entire continuum of criminal sexual behaviors, including completed or attempted unwanted sexual contact that may or may not include force, such as intentional grabbing or touching of the genitalia, anus, groin, breast, inner thigh, or buttocks. Noncontact acts, including voyeurism and verbal and behavioral sexual harassment, are also typically defined as sexual assault.
Although the anti-rape movement has improved the responsiveness of legal, health, and social service systems, rape remains a major public health problem in the United States. Rapes continue to be committed, often resulting in physical and psychological consequences for survivors. There is also a high economic toll from rape. In 2003, economic loss due to rape and sexual assault was $42 billion. Female survivors carry the burden of most of these consequences. Rape is a form of gender-based violence due to the disproportionate number of assaults against women. Women are about 10 times more likely to be raped in adulthood compared to men. From 1992 to 2000, 89% of all completed and attempted sexual assaults were committed against females. Most perpetrators of rape are male and many are current or former intimate partners of the survivors.
Prevalence
The National Violence Against Women Survey found that 18% of women reported experiencing a completed or attempted rape during their lifetime compared to 3% of men. Lifetime rates of rape among adult women range from 2% to 97%. The majority of estimates converge around 15%. The variability in prevalence rates is influenced by different sample characteristics and research methodologies used across studies. Higher estimates have been reported among some populations of women, including those who are surveyed in health care settings and on college campuses and military bases. The use of behaviorally specific questions (e.g., using force or threatening harm) is associated with higher reporting rates compared to questions that rely on jargon, such as rape and sexual assault about which even researchers disagree. The use of such terms contributes to underreporting among women who do not label their experiences as rape due to the lack of force, familiarity with the perpetrator, or impairment by alcohol or drugs. Prevalence rates based on crime report surveys also underestimate the size of the problem. Approximately 5% to 36% of rape survivors appeal to the criminal justice system for assistance. Common barriers to reporting include fears of being blamed for the assault and expectations of receiving little or no help.
Risk Factors
Survivor Characteristics
Women first experience rape at a young age, typically before age 18. Single marital status, low socioeconomic status, and low education level are also associated with increased risk of sexual victimization. The literature on ethnic differences suggests that American Indian women are more likely to report being raped compared to all other races; however, the findings are largely based on studies that group all American Indians in one category. Comparisons across tribes show that some tribes have higher estimates of rape compared to the general population, whereas others have lower or similar rates. Ethnic differences are also subject to the effects of minority status, frequently characterized by exposure to poverty and life stressors and lack of educational and employment opportunities. Rape vulnerability among women is also associated with history of sexual victimization, mental or emotional difficulties, alcohol and drug abuse, and certain personality traits.
Perpetrator Characteristics
Men who commit sex offenses are more likely to have deviant sexual arousal, pro-offending attitudes, antisocial characteristics (e.g., impulsivity), and unstable social resources. Male sexual aggression is also linked to childhood behavior problems and abuse of alcohol or drugs.
Sociocultural Factors
Rape vulnerability also includes the larger social context that promotes violence against women. Rapeprone environments, such as college campuses with high rates of binge drinking, and specific social groups (e.g., college fraternities, athletic teams) have received increased attention. Some fraternities, but not all, are at increased risk of sexual violence. Fraternities at greatest risk are characterized by a culture of excessive drinking, peer support for sexual violence, and reinforced pro-offending beliefs (e.g., hostility toward women and stereotypical views of masculinity and heterosexuality).
Consequences
Rape results in many immediate and long-term physical and psychological consequences. Responses to rape vary by individual. Some women experience chronic, long-lasting psychological symptoms, whereas others report few or no symptoms at all. Responses to rape are influenced by a number of factors, including the nature of the assault, previous mental or emotional difficulties, history of victimization, life stressors, coping skills, social support, and other available resources.
Physical Consequences
Acute Injuries
About a third of female rape survivors sustain some type of injury. Physical injuries include scratches, bruises, lacerations, broken bones, head and spinal cord injuries, muscle sprains, internal injuries, and dental damage. A woman is at increased risk of injury if the perpetrator threatens to harm or kill her or someone close to her. In the most extreme cases, rape is accompanied by death; however, rape-related deaths are rare.
Chronic Health Problems
Rape survivors are vulnerable to health problems that persist over time, including gastrointestinal disorders and chronic pain located in the back, neck, head, face, and jaw. Gynecological problems following a rape, such as chronic pelvic pain, premenstrual symptoms, irregular vaginal bleeding, and painful intercourse, are also common. Survivors are also at increased risk of HIV and other sexually transmitted diseases (STDs), infertility due to untreated STDs, and unwanted pregnancies.
Psychological Consequences
Immediate Responses
Immediately following a rape, survivors may react with intense fear, shock, anxiety, confusion, disbelief, helplessness, withdrawal, guilt, shame, and low self-esteem. Some survivors report symptoms of posttraumatic stress disorder (PTSD), including flashbacks and sleeping problems. It is also common for survivors to avoid sexual intimacy and experience diminished interest in sex, reduced arousal, and difficulties achieving orgasm shortly after the assault.
Posttraumatic Stress Disorder
One of the most common, longer-lasting psychological outcomes of rape is posttraumatic stress disorder (PTSD). As defined by the American Psychiatric Association, a PTSD diagnosis is based on an exposure to an identifiable traumatic event that produces intense fear, helplessness, or horror and the presence of specific symptoms, such as reoccurring recollections of the event, persistent avoidance of trauma related stimuli, numbness, and increased alertness to potential threats. Estimated rates of PTSD among survivors are between 30% and 65%. Most survivors experience a reduction in PTSD symptoms within a few months; however, for others, the symptoms become chronic and remain elevated for months or years. Some researchers and practitioners argue against using PTSD as a primary diagnosis for rape survivors because it does not capture the complex responses reported by some survivors. It is particularly ill fitting for women who have experienced repeated or escalating forms of sexual violence. Two alternative diagnoses are complex PTSD and disorders of extreme stress not otherwise specified.
Other Psychological Consequences
Rape initiates or exacerbates many other forms of psychological distress, including anxiety, major depression, sexual dysfunction, disordered eating behaviors, physical symptoms without the presence of medical conditions, and severe preoccupations with physical appearances. Rape survivors are also more likely to have suicidal thoughts and to attempt or commit suicide more often than nonvictims. Some survivors engage in self-mutilation and high-risk behaviors (e.g., driving while intoxicated, unprotected sex, and alcohol and drug abuse). Rape also contributes to elevated likelihood of future sexual assault. Rape may have a negative impact on survivors’ perceptions of themselves and the world around them. Some women blame themselves for the assault and perceive the world to be hostile and dangerous. Distorted and negative beliefs contribute to heightened distress among survivors. Strained relationships with family, friends, and intimate partners are also common.
Economic Cost
Rape is costly in the United States. In 1996, for example, the estimated costs of sexual violence in Michigan alone were more than $6.5 billion. The economic toll of rape consists of expenses for medical care, mental health treatment, victim services, and criminal justice responses and lost productivity from injury and other consequences. A third of women who sustain an injury seek medical treatment and most receive services from hospitals. In general, rape survivors seek medical assistance more often than nonvictims. Costs are also associated with high rates of poverty and unemployment following victimization.
Prevention
The three levels of prevention in public health may be applied to rape. Primary prevention seeks to reduce the likelihood of rapes being committed in the first place. Primary prevention approaches focus on increasing rape awareness and changing environments that are conducive to sexual aggression. This change is often accomplished with prevention and education programs on rape awareness, healthy relationships, alcohol and drug use, and self-defense and resistance techniques. Programs typically target adolescents, parents, teachers, and college students. Programs for men emphasize rape myth acceptance, rape empathy, power dynamics, relationship expectancies, and coercive sexual behaviors. Prevention programs are effective in increasing rape knowledge and altering rape attitudes, but the long-term effectiveness on behavioral variables and incidence of sexual assault remains unknown.
Secondary prevention efforts attempt to reduce the impact of rape after it has occurred. They include violence screening practices and early intervention approaches. Violence screening tools facilitate early detection of victimization and treatment referrals. Tertiary prevention consists of treatment services to reduce the likelihood of chronic problems and long-term disability. Interventions for rape survivors are discussed in the following section.
Prevention and intervention approaches for male perpetrators are beyond the scope of this essay; however, a brief comment on prevention is provided to highlight the responsibilities of perpetrators. Prevention strategies targeting perpetrators attempt to decrease first offenses, reduce the likelihood of repeat offenses, and minimize escalation among those who have already perpetrated an illegal sex act. Prevention methods also include efforts by the criminal justice system to deter offending, including prison terms, probation, mandatory registration, community notification, and civil commitment.
Intervention
Treatment Approaches
No single therapeutic approach for rape survivors has been shown to be dramatically more effective than all others. Recommended treatments include therapies that have been proven effective in rigorous scientific investigations. These therapies, referred to as empirically based treatments, incorporate cognitive and behavioral techniques. Cognitive approaches attempt to reduce distress by helping survivors identify and change negative thoughts related to the traumatic event. Behavioral approaches typically consist of exposure techniques that guide the survivor in reliving memories of the traumatic act and other difficult experiences that developed during the aftermath. Most of these therapies may be implemented in individual and group formats. Alternative treatments that have not undergone as much scientific testing, such as eye movement desensitization and reprocessing, are also shown to alleviate distress among survivors.
Advocacy And Public Policy
Improvements in the care of rape survivors are largely the result of victim advocacy work and legislation on violence against women. Rape work began as a grassroots movement in the 1970s that led to the development of rape crisis centers, state coalitions, and national organizations to address the inadequate responses offered by medical providers and law enforcement. The Violence Against Women Act (VAWA) of 1994, the first legislation on violence against women, recognized the serious harm inflicted on survivors of physical and sexual violence and allotted resources to assist survivors, children, and families. Two reauthorizations of the law include VAWA 2000 and 2005. VAWA 2005 includes development of programs for underserved communities (e.g., homeless, disabled, elderly, Native Americans, ethnic minorities, legal immigrants, and survivors from rural areas) and increased attention to violence prevention.
Given the current period of limited funding, there is a need to maximize efforts to prevent rape and reduce the impact on survivors. Recommendations include strategies for combining resources and developing collaborations across diverse disciplines. Survivors would benefit from more coordinated community responses among health care, criminal justice, and legal systems. Increased communication and integration of community services is especially relevant for populations of women who have limited access to specialized victim services, including women who are homeless, from ethnic minority backgrounds, or who live in rural areas. More collaboration among researchers and community providers would help reduce the gap between effective practices and what is actually available to survivors in the community. Partnerships with policymakers are also equally important to develop a dialogue that matches the needs of the field with legislative vehicles for enhancing resources and influencing the work that is done. Together, these collaborative efforts may accelerate progress in creating environments that are safe for all women and responsive to those who have survived rape so that they may obtain the resources they need to recover.
Bibliography:
- Briere, J., & Jordan, C. E. (2004). Violence against women: Outcome complexity and implications for assessment and treatment. Journal of Interpersonal Violence, 19, 1252–1276.
- Rennison, C. M. (2002). Rape and sexual assault: Reporting to police and medical attention, 1992–2000. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics.
- Rozee, P. D., & Koss, M. P. (2001). Rape: A century of resistance. Psychology of Women Quarterly, 25, 295–311.
- Tjaden, P., & Thoennes, N. (2000). Full report of the prevalence, incidence, and consequences of violence against women. Washington, DC: U.S. Department of Justice, National Institute of Justice.
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