Sexual coercion: Time to rise to the challenge

Abstract

Byline: T. Sathyanarayana Rao, Mehak. Nagpal, Chittaranjan. Andrade Much has been said, discussed, and reported in the media in the wake of the December 16, 2012, Delhi rape and murder incident, and a myriad other incidents of sexual crime in the country. It is therefore important for mental health professionals to re-examine psychosocial issues related to sexual coercion in the context of the current public debates on the subject. Sexual coercion is the act of being physically, psychologically, financially or otherwise forced or tricked into engaging in sexual activity; victims are most commonly women and children. Women run the risk of sexual abuse and violence across their whole life span. The risk of partner violence and rape, including dating violence and domestic violence; begins in late adolescence, peaks by middle age, and may even continue in the elderly. These acts are not a distinct phenomena and have a degree of overlap that can be viewed along a continuum of sexual violence as they have common causes and methods of prevention. [sup][1],[2] It is commonly believed that sexual coercion is perpetrated by the male sex against the female sex. However, this gender effect is less pronounced in child sexual abuse where women represent a large proportion of perpetrators and children of both sexes are subjected to sexual advances from adolescents and adults. Childhood sexual abuse includes three important elements: (1) Age and size difference between the child and perpetrator; (2) presence of sexual behaviors such as nudity, fondling, and penetration; and (3) gratification to the perpetrator. [sup][3],[4] Sequelae of coercive sexuality in children include subsequent development of sexual disorders, emotional instability, interpersonal withdrawal, and maladaptive coping in new situations. In young women, self-blame, guilt, shame, poor self-esteem, mistrust of others, and other repercussions get reflected in relationships and can be enduring. In any case of child sexual abuse, rape, domestic violence, or elder abuse; there is a common thread of betrayal, vulnerability, and ambivalence in the social norms that tolerate the abuse and the abuser. Role of Mental Health Practitioners and Physicians As is with all forms of sexual assault, the most serious health effects of rape are not physical but psychological. While some acts may traumatize the survivor immediately, other acts may additively manifest many years later, making it more difficult over time to resist overt acts of aggression. Long-term clinical problems include hypervigilance, anxiety and phobias, somatic complaints, dissociative disorders, depression, substance abuse, suicide attempts, and risk of revictimization. [sup][5] While most abuse associated with fatality occurs to young children, adolescent abuse can lead to risk taking behavior that, in turn, increases the risk of current and later morbidity and mortality. [sup][6] Clinicians must therefore recognize that recurrent injury at each stage of a woman's life cycle is predictable; and it requires safety planning in order to address the intratraumatic stress responses. [sup][2] There is also an urgent need to target the commonplace barriers to physician involvement, such as lack of training and awareness about community services, time constraints, and unresolved personal issues that would facilitate a nonjudgmental and supportive safe encounter with the victim. [sup][7] The role of a physician is not just to evaluate, document, and treat women who have been sexually assaulted. They also serve as an educator to guide the victim, her family, and those who become involved in her care. Here, it may be noted that it is important to address a common misperception in society that if women avoid certain behaviors they are not vulnerable to sexual assault. This belief and the subsequent tendency to blame; especially by the main supportive caregivers of the victim, needs to be addressed openly. …