Childhood Rape Research Articles

Expertise psychiatrique : quelle est la responsabilité pénale en cas de consommation de cannabis ?

Resume Introduction La consommation de cannabis est depuis quelques annees un probleme de sante publique en France, notamment par la democratisation de cette drogue chez les jeunes. Bien que la legislation soit claire en ce qui concerne la responsabilite des personnes sous l’emprise de stupefiants en cas d’infractions, il n’est pas rare que les personnes soient reconnues irresponsables ou partiellement responsables. L’objectif de cette etude est de determiner si une consommation de cannabis au moment des faits est retenue par les experts comme un facteur de d’alteration ou d’abolition du discernement. Methode Une etude descriptive retrospective realisee dans la region PACA aupres de six experts a recueilli 96 expertises penales en responsabilite pour des infractions commises sous l’emprise de cannabis entre 2016 et 2018. Le critere d’evaluation principal etait le discernement, defini soit comme aboli, altere ou non modifie. Les objectifs secondaires etaient d’observer les facteurs associes a une modification de celui-ci. Resultats La consommation de cannabis n’a pas d’impact sur le degre de discernement. La dependance au cannabis chez l’auteur des faits n’est pas significativement associee a une atteinte du discernement. En revanche, le sexe masculin, l’existence d’un trouble de la personnalite, une immaturite affective, les antecedents psychiatriques, un suivi psychiatrique ou addictologique au moment des faits et une decompensation psychotique sont significativement associes a une atteinte du discernement. Conclusion Ces resultats soulignent l’importance des mesures de prevention et de reduction des risques lies au cannabis, notamment dans ce contexte de legalisation ou depenalisation du cannabis.

Gender, Madness, Religion, and Iranian-American Identity: Observations on a 2006 Murder Trial in Williamsport, Pennsylvania

Using participant observation, oral history interviews, and a study of court transcripts, Internet chats, and press coverage of a 2006 murder trial of an Iranian-American man in Williamsport, Pennsylvania, we can better appreciate the dynamic intersection of ethnicity, religion, and gender in constructing the social identity of Iranian-Americans. Brian Hosayn Yasipour, who immigrated to the United States in 1969, was convicted of murder in the third degree for killing his four-year-old daughter in 2001 during a custody dispute with his estranged, Iranian-born wife. He managed to avoid the death penalty. Debates about his guilt in America hinged on assessments of his mental state at the time of the crime and this, in turn, hinged on debates about how normative his actions would have been in Iran. Until his arrest, Brian had led a highly mobile life—moving back and forth between America, where he lived as a Christian, and Iran, where he visited as a Muslim. Was he a calculating Iranian-Islamic patriarch, outraged at the defiance of his wife and the attitudes of American courts toward his paternal rights? Or was he, per the court transcripts, a “white Christian” and survivor of childhood rape back in Iran, who lapsed into madness under the strain of his second divorce? Brian actively blurred these issues in court appearances before and after the murder—often expressing his agency in terms of preserving his imaginary and physical mobility.

Women Mental Health and Well-being: A New Paradigm

This paper reviews literature on the determinants of women’s mental health through a stigma of mental illness and gender perspectives. This approach stresses that women’s particular health needs have been neglected in a male-centred models of health, and argues for the importance of addressing these needs in a way that views women and their lives holistically. A woman in social context is seen as parents and their roles have been demonstrated from their life within the family and society as well. This article draws attention to the women and physical health instead of looking at mental illness alone. The impact of violence against women, in particular, the effects of childhood sexual abuse, domestic violence and rape has been illustrated in western and Indian perspectives. In recommendations initiatives in mental health services especially, for women mental health has been emphasized broadly.

Associations between nonauditory hallucinations, dissociation, and childhood adversity in first-episode psychosis

ABSTRACTAlthough repeated associations have been found between adversity exposure (particularly exposure to childhood sexual abuse), dissociation, and auditory hallucinations in the context of psychosis, there is little comparable research examining hallucinations in other modalities. This study aimed to determine whether cumulative adversity exposure influences the likelihood of experiencing visual, tactile, olfactory, and gustatory hallucinations among psychosis patients and whether measures of dissociation are significantly associated with nonauditory hallucinations when exposure to childhood adversity and psychological distress are adjusted for. Self-report measures and a retrospective case-control design were applied to assess nonauditory hallucinations, dissociation, psychological distress, and childhood adversity exposure in a sample of first-episode psychosis patients reporting nonauditory hallucinations (n = 36) and controls from the same clinical population without nonauditory hallucinations (n = 31). Case participants reported higher levels of dissociation, psychological distress, and exposure to childhood rape than the control group. Dissociation remained significantly associated with nonauditory hallucinations when we adjusted for childhood sexual abuse, other types of childhood adversity, and a combined measure of emotional distress. Indication of a dose–response relationship was detected, in that total number of adversities was significantly associated with reporting more than one modality of nonauditory hallucination. Observed associations between auditory hallucinations and dissociation in psychosis may extend to other hallucination modalities. It is suggested that more research attention be paid to the etiology and impact of nonauditory hallucinations in psychosis samples.

Examining the associations between sex trade involvement, rape, and symptomatology of sexual abuse trauma.

The high prevalence of rape and sexual trauma symptomatology among women involved in street-based sex trades is well-established. Because prior research has lacked appropriate, non-sex trade involved comparison groups, it is unknown whether differences exist among similarly situated women who do and do not trade sex. This article explores experiences of childhood and adult rape and symptomatology of sexual abuse trauma among a community-based sample of 322 women who use methamphetamine in San Francisco, California, 61% of whom were involved in the sex trade. Study participants were recruited via respondent-driven sampling and eligible if they were cisgender women, aged 18 or older, current methamphetamine users, and sexually active with at least one cisgender man in the past 6 months. The dependent variable was sexual abuse trauma symptomatology, as measured by the Sexual Abuse Trauma Index (SATI) subscale of the Trauma Symptom Checklist-40 (TSC-40), and the explanatory variable was sex trade involvement. Potential covariates were age, current homelessness, methamphetamine dependence, and experiences of childhood and adult rape. Sixty-one percent of participants had a SATI subscale score suggestive of sexual abuse trauma. The overall prevalence of rape in childhood and adulthood was 52% and 73%, respectively. In bivariate analysis, sex trade involvement and all of the potential covariates except for homelessness and age were associated with a SATI score suggestive of sexual abuse trauma. In multivariate models controlling for significant covariates, there was no longer a statistically significant association between sex trade involvement or childhood rape and an elevated SATI score. Elevated levels of psychological dependence on methamphetamine and experiences of rape as an adult were still associated with a high SATI score. These findings highlight that urban poor women, regardless of sex trade involvement, suffer high levels of rape and related trauma symptomatology.

23. Allostatic associations in women veterans with histories of childhood sexual assault

Women veterans have increased sexual victimization before entering the military and increased military sexual trauma (MST). Using the allostatic load model, we studied relationships between hair cortisol, cardiovascular and inflammatory biomarkers, stress, pain, PTSD, and history and frequency of childhood rape or attempted rape in 81 women veterans. The latter was reported by 27 women (33%). There was a trend for lower hair cortisol in these women [t(63.92) = 1.91, p = .06], suggesting a dampened hypothalamic–hypophyseal–pituitary axis. These women also had higher cholesterol [t(69) = −2.62, p = .01] and triglycerides [t(68) = −2.23, p = .03], higher perceived stress scores [t(77) = −2.00, p = .05], greater pain [t(78) = −3.32, p = .01], greater fatigue [t(77) = −2.03, p = .05], and there was a trend for lower plasma IL10 [t(56.75) = 1.87, p = .07] than women veterans without this history. We did not find evidence of higher CRP or IL-6 as has been reported in other studies, but many of these women were on medications that could suppress inflammation (antidepressants, anxiolytics, anti-hypertenives, statins, and anti-inflammatories). Of the 27 women who reported childhood sexual assault, 10 (37%) also reported MST. These data suggest that some women veterans who have suffered childhood sexual assault are vulnerable and have increased allostatic load and propensity for a variety of later illnesses.

Naltrexone and prazosin combination for posttraumatic stress disorder and alcohol use disorder.

To the Editor: Posttraumatic stress disorder and alcohol use disorder often co-occur. We report a case in which combination treatment with naltrexone and prazosin was effective for both disorders. Case report. Mr A, a 37-year-old married man diagnosed with major depressive disorder and alcohol use disorder, was admitted in August 2013 to the co-occurring inpatient unit at Sheppard Pratt Health System, Baltimore, Maryland. He endorsed having hypomanic episodes in the past, and the diagnosis was changed from major depressive disorder to bipolar II disorder (DSM-5 criteria). Mr A was physically abused as a child by his father. He reported posttraumatic stress disorder (PTSD) symptoms that were experienced only during daytime, without PTSD-related nightmares or sleep problems. He was diagnosed with PTSD (DSM-5 criteria) during this admission. His active medications included fluoxetine 40 mg daily and quetiapine 50 mg for sleep (which was not related to PTSD). These medications were discontinued because they were not indicated for bipolar depression and insomnia, respectively. Oral tablets of lithium 600 mg, prazosin 1 mg, and naltrexone 25 mg daily were started. On day 2, prazosin was increased to 1 mg twice daily, and naltrexone was increased to 50 mg at bedtime. Lithium was increased from 900 mg to 1,200 mg (lithium level 0.99 mEq/L) at bedtime after the lithium level was found to be low with 900 mg. Alcohol craving and flashbacks decreased in 4 days. There was a complete remission of alcohol craving and flashbacks in 2 and 4 weeks, respectively. To date, Mr A has been abstinent from alcohol for 6 months. There is a high comorbidity between PTSD and alcohol use disorder. More than 50% of Vietnam combat war veterans with PTSD subsequently developed alcohol use disorder.1 Woman with PTSD from childhood rape often self-medicate with alcohol to reduce symptoms of PTSD.2 Naltrexone is an opioid antagonist used for the treatment of alcohol use disorder. In an animal study, naltrexone prevented increased alcohol consumption following trauma.3 Prazosin, an α1-adrenergic antagonist, is effective for nightmares in PTSD.4 In a recently published review, patients with PTSD treated with prazosin reported almost complete remission of daytime symptoms such as hyperarousal, flashbacks, and daytime reexperiencing of the trauma.5 Prazosin reduced alcohol self-administration in rodents.6 Prazosin decreased stress and cue-induced alcohol craving in people with alcohol use disorder.7 In humans, there is evidence to support that prazosin reduces consumption of alcohol.8 In a randomized controlled trial, prazosin was shown to be efficacious for alcohol use disorder.9 There is evidence to support the use of naltrexone for PTSD.10 Both medications have been approved by the US Food and Drug Administration. Individual pharmacotherapy is effective for the treatment of PTSD and alcohol use disorder; however, no medications have been proven to be effective for these co-occurring disorders. Individuals with co-occurring PTSD and alcohol use disorder report increased alcohol craving following exposure to personalized trauma cues, in the absence of cues related to alcohol.11 This co-occurring disorder may be associated with severe clinical impairment with more relapses. Alcohol-preferring rats were fed naltrexone and prazosin alone or in combination for 4 weeks, and the effect of drug treatment on alcohol was assessed.12 The combination of naltrexone and prazosin was significantly more effective in reducing alcohol intake than either drug alone. The authors concluded that naltrexone and prazosin combination reduced alcohol consumption.12 This novel treatment with naltrexone and prazosin, which may have a synergistic effect, was effectively used in the management of our patient. This combination was safe, effective, and tolerable. To our knowledge, this is the first case report on the use of the combination of naltrexone and prazosin for PTSD and alcohol use disorder. This therapeutic strategy should be considered by clinicians in the management of these challenging co-occurring disorders, as it may lead to better outcomes. Future randomized clinical trials are warranted to validate this finding.

Overturning the Sudden End: New Interpretations of Catastrophe

Overturning the Sudden End: New Interpretations of Catastrophe

The Catastrophe of Childhood Rape: Traversing the Landscape between Private Memory and Public Performance

The Catastrophe of Childhood Rape: Traversing the Landscape between Private Memory and Public Performance

Physical health status of female veterans: contributions of sex partnership and in-military rape.

The aim of this study was to determine whether current physical health status in female veterans is associated with rape during military service and same-sex partnership. Retrospective computer-assisted telephone interviews of 1004 Midwestern US female veterans identified from Veterans Affairs electronic records were conducted. Data included rape history including rape in military, sex partnership history, demographics, and medical history including chronic pain, mental health (depression and posttraumatic stress disorder [PTSD]), and the physical health component of the Short-Form 12-item interview (PCS-12). Physical health in this sample was lower than norm values [PCS-12: mean (standard deviation) = 43 [12]; norm: mean (standard deviation) = 50 [10]). Fifty-one percent of the participants reported rape in their lifetime, 25% reported rape in military, 11% reported history of women as sex partners, and 71% reported history of chronic pain. Multiple regression analysis indicated that physical health (PCS-12) was associated with chronic pain history (β = -.40, p < .001), rape in military (β = -.09, p = .002), and current PTSD (β = .07, p = .03), adjusting for demographic data. Mediational analysis indicated that chronic pain history significantly mediated relationships of women who have sex with women, childhood rape, PTSD, depression, and current substance use disorder with PCS-12. Both rape and sex partnership are adversely associated with lower physical functioning in female veterans. Clinicians evaluating the physical health of this population should therefore consider obtaining detailed sexual histories, and a multidisciplinary team is needed to address mental health issues in female veterans.

Do Specific Early-Life Adversities Lead to Specific Symptoms of Psychosis? A Study from the 2007 The Adult Psychiatric Morbidity Survey

Previous studies have reported associations between childhood adversities, eg, loss of a parent, being raised in institutional care, sexual and other kinds of abuse by adults and bullying by peers, and psychosis in adulthood. However, the mechanisms by which these adversities lead to psychotic experiences are poorly understood. From models of the psychological processes involved in positive symptoms, it was predicted that childhood sexual abuse would be specifically associated with auditory hallucinations in adulthood, and that disruption of early attachment relations and more chronic forms of victimization such as bullying would be specifically associated with paranoid ideation. We therefore examined the associations between sexual trauma, physical abuse, bullying, and being brought up in institutional or local authority care and reports of auditory hallucinations and paranoid beliefs in the 2007 Adult Psychiatric Morbidity Survey. All simple associations between childhood adversities and the two symptom types were significant. Childhood rape was associated only with hallucinations (OR 8.9, CI = 1.86-42.44) once co-occurring paranoia was controlled for. Being brought up in institutional care (OR = 11.08, CI = 3.26-37.62) was specifically associated with paranoia once comorbid hallucinations had been controlled for. For each symptom, dose-response relationships were observed between the number of childhood traumas and the risk of the symptom. The specific associations observed are consistent with current psychological theories about the origins of hallucinations and paranoia. Further research is required to study the psychological and biological mediators of these associations.

Rape, sex partnership, and substance use consequences in women veterans

The association of rape history and sexual partnership with alcohol and drug use consequences in women veterans is unknown. Midwestern women veterans (N = 1,004) completed a retrospective telephone interview assessing demographics, rape history, substance abuse and dependence, depression, and posttraumatic stress disorder (PTSD). One third met lifetime criteria for substance use disorder (SUD), half reported lifetime completed rape, a third childhood rape, one quarter in-military rape, 11% sex with women. Lifetime SUD was higher for women with rape history (64% vs. 44%). Women with women as sex partners had significantly higher rates of all measures of rape, and also lifetime substance use disorder. Postmilitary rape, sex partnership, and current depression were significantly associated with lifetime SUD in multivariate models (odds ratio = 2.3, 3.6, 2.1, respectively). Many women veterans have a high need for comprehensive mental health services.

Self-Injurious Behavior in a Community Sample of Young Women

The prevalence of self-injurious behavior (SIB) in the general population is unknown. The present study aims to assess the prevalence and dimensionality of a large spectrum of SIBs in a community sample of young women. A cohort of female subjects aged 18 through 25 years resident in 2 areas of a large city was involved in the study, which was conducted from December 1996 to August 1998. Subjects (N = 934) underwent a clinical interview to assess the presence of SIBs, childhood sexual and physical abuse, suicidality, use of illicit drugs, alcohol abuse, and DSM-IV lifetime eating disorder diagnosis. About 24% of the sample reported some type of SIB. The factor analysis revealed that the different types of SIBs tend to group into 4 dimensions: 2 characterized by impulsive features and the other 2 by compulsive features. Body image disturbance (p < .01), emotional distress (p < .001), alcohol/substance misuse (p < .05), and suicide attempts (p < .01) were significantly associated with both compulsive and impulsive SIBs. In addition, the presence of impulsive SIBs was significantly predicted by a lower level of education (p < .05), lifetime eating disorders (p < .01), and childhood abuse (p < .05), whereas skin picking/self-biting was predicted by childhood sexual molestation (p < .04) and childhood rape (p < .005). Self-injurious behaviors are common among young women. There is a significant association between SIBs and other forms of direct and indirect self-damaging behaviors, including alcohol abuse, use of illicit substances, suicidality, and eating disorders. Further research is needed to better understand the nosology of this spectrum of behaviors.

Childhood traumas and hallucinations: An analysis of the National Comorbidity Survey

Data from the National Comorbidity Survey were used to estimate the relationship between occurrences of childhood trauma and self-reported experiences of hallucinations. Variables representing (1) childhood neglect, (2) childhood physical abuse, (3) rape under the age of 16, and (4) molestation under the age of 16 were used to predict experiences of visual, auditory and tactile hallucinations. After controlling for background variables (sex, age, depression, family history of depression, urbanicity, income, drug, and alcohol dependence), a history of childhood rape and molestation were significantly associated with visual, auditory and tactile hallucinations. Additionally, neglect was associated with visual hallucinations and physical abuse with tactile hallucinations. Experiencing multiple types of trauma was associated with increases in the likelihood of reporting each of the three types of hallucinations. Hallucinatory experiences are possible indicators of a traumatic childhood history.

Piloting post-exposure prophylaxis in Kenya raises specific concerns for the management of childhood rape

Thika District, Kenya, is the site of an operational research study on the provision of comprehensive post-rape care, including the free provision of HIV post-exposure prophylaxis (PEP). It is a typical rural Kenyan district in terms of resources and patient throughput. The high rate of children attending for post-rape services was unexpected and had significant programming implications. An age-disaggregated analysis of existing quantitative data from the first 8 months of service provision was conducted. Ninety-four case records were reviewed, of whom 48 (51%) were in the age range 1.5-17 years inclusive. All three cases of male rape were in children. Children were more likely to know their assailant than adults and were more likely to be HIV-negative at baseline. The majority (86%) of children presented in time for PEP, with adherence and completion rates similar to adults but lower rates of 6-week follow-up. The use of weight bands to determine drug dosages greatly simplified the appropriate and early administration of paediatric PEP. The high rates of childhood rape and demand for post-rape services were an enormous challenge for service providers and policy-makers.

Impact of an abuse history on the health outcomes among blacks and whites with chronic pain

The association between physical and sexual abuse among men and women with chronic pain is under-examined. We hypothesized that the pain experience for men and women with an abuse history differed according to abuse type and age at which abuse occurred. A prospective cohort study involving chronic pain patients 18-50 years at a tertiary care pain center was conducted. Data on sexual and physical abuse (Drossman Abuse Questionnaire; DAQ), pain severity, functioning and PTSD were collected. Participants completing the DAQ were included in analyses (N 165; 91% response). Most subjects were women (64%), educated (68% high school), in a long-term relationship (51%), employed (59%), and White (50%). Prior analysis identified six 3-item abuse factors (a .77-.91): sexual molestation, sexual penetration (rape), and physical abuse in both childhood and adulthood. Decreased general health was associated only with rape in childhood (p .03). However, decreased mental health was associated with molestation, penetration, and physical abuse in childhood (p .02; .004; .01 respectively) and adult physical abuse (p .05). While increased sensory pain was associated only with physical abuse in adulthood (p .04); affective pain was associated with all abuse scales in childhood and molestation and physical abuse in adulthood; though molestation in childhood was predictive only of higher affective pain for men (p .03). Decreased functioning was predicted by childhood rape (p .03). Regarding PTSD, men with childhood or adulthood molestation (p .01; p .008) and penetration (p .02; p .03) reported more PTSD than non-abused men. Overall an interaction between pain experiences and abuse patterns was identified. Pain is perceived more emotionally by abused people. In some measures this is more true for men than women. These findings support the clinical need to enquire about an abuse history from both men and women. Further research should evaluate pain’s affective component in abused men and women.

Is Disclosure of Childhood Rape Associated with Mental Health Outcome? Results from the National Women’s Study

Clinicians often assert that disclosure of childhood rape is beneficial to victims because it sets the occasion for protective action and can bring them into contact with professionals trained to address rape-related mental health needs. Consistent with this is the hypothesis that victims of childhood rape who disclose their victimization soon after it occurs are at lower risk for later psychosocial difficulties relative to those who delay disclosure or never disclose. We explored this issue with a nationally representative sample of 3,220 adult women; 288 (8.9%) endorsed at least one instance of forcible sexual penetration prior to age 18. Results revealed a significantly higher past-year prevalence of posttraumatic stress disorder (PTSD) and major depressive episodes among women who waited longer than 1 month to disclose their rape relative to nondisclosers and women who disclosed within 1 month of the rape. Delayed disclosure remained associated with PTSD after controlling for demographic and rape characteristics. Patterns of disclosure were not associated with past-year substance-use problems.

Obsessions meurtrières, étude d'un cas

Is it possible to prevent serial murders by treating the subject before he acts? The study of case A with an obsessive compulsive symptomatology and hospitalised for one year in the ‘unit for problem patients’ revealed a very severe extremely obsessive murderous problematic with a perverse sadistic and necrophilic scenario. The young man had been convicted as a minor for burglary, abduction and sexual aggression; he had been judged to be fully criminally resposible and diagnosed by experts with a psychopathy. His personal history showed a devalued narcissistic image as well as a childhood rape and a botched circumcision. His progress within our department followed four lines: his depression and self-mutilation behaviour faded; as did the washing rituals; the sadistic murder problematic was eventually treated as a productive expression, as acoustical-verbal phenomena were also observed. A treatment associating serotoninergic antidepressants, Leponex ® and antihormone (Androcur ®) clearly reduced the overall symptomatology, leaving unanswered the following question: sexual psychopath or special form of schizophrenia?

Predictors of medical examinations following child and adolescent rapes in a national sample of women.

Childhood rape occurs frequently in our society and is associated with adverse consequences. Despite the severity of these outcomes, there appear to be many obstacles for children to receive postrape medical care. To date, it is unclear what proportion of childhood rape victims receive postrape medical examination or what factors predict receipt of this medical care. This study instigated the factors predicting immediate medica care for women who were raped during childhood. Data for the study were obtained from the final wave of the 2-year, longitudinal National Women's Study. Results indicated that the majority of women did not receive medical care following their childhood rape. Although women raped as adolescents were more likely to receive a postrape exam, logistic regression analyses indicated that rape characteristics (e.g., reporting the assault, concerns about sexually transmitted diseases [STDs]) mediated the relationship between age of victimization and receipt of medical care. Implications of these findings are discussed.

Childhood abuse and premilitary sexual assault in male Navy recruits.

Three samples of male U.S. Navy recruits (N = 7,850) were surveyed to determine whether a history of childhood physical abuse (CPA) or childhood sexual abuse (CSA) was predictive of premilitary rape of women and whether these relationships were mediated by alcohol problems and number of sex partners. In the 3 samples, 11.3%, 11.6%, and 9.9% of men reported committing premilitary rape. When demographic factors were controlled for, both CPA and CSA were independently and additively predictive of rape in each sample, with men who experienced both forms of abuse showing the highest risk of committing rape. Additional analyses revealed that alcohol problems and number of sex partners significantly mediated the relationship between childhood abuse (CPA and CSA) and rape perpetration.