CVSS2123ExamOne

• Power Reassurance
• Power Assertive
• Anger Retaliatory
• Anger Excitation

No - 11/01/2009 - Hospitals are not required to report rape, rape by instrumentation, or forcible sodomy committed on adult victims, unless the victim requests the crime be reported to law enforcement.

2008 - SANE exams free for rape victims whether or not they choose to report to law enforcement

Rape is a physical assault that is perpetrated sexually and includes the elements of anger, power/control, and sexual contact.

8th worst in the nation

1 in 3

1 in 7-10

1 in 5

1 in 33

Washington DC in 1972

• ♀ were property of their fathers
• brides were purchased by the groom/his family
• bride price was paid to compensate fathers for their loss of property
• possession of the ♀ (property) passed from father to husband

The Women's Movement

Polygraph

• - most common & least violent
• - easiest to profile & catch
• - usually starts as peeping tom
• - ritualistic

minimal to moderate

• reassurance of masculinity
• elevate self-esteem
• does not intend to hurt/degrade victim

• only enough force to control victim
• if he needs a weapon, chooses one from the home of the victim
• pre-selects victim through surveillance/peeping; may have several victims selected in advance
• typically uses surprise approach
• attacks in/near victim's residence
• attacks occur between midnight & 5am (often a dead giveaway to this type of rapist)
• victim is home alone or with small children, will not go in if a ♂ is present
• victim is close to his age
• may request victim to talk dirty but uses little profanity himself
• may re-contact victim
• takes souvenirs  - most popular are drivers' licenses, lingerie & photos
• has victim remove her own clothes, often exposes only body parts necessary for rape to occur
• keeps records - diaries, newspaper clippings, computer files
• may spend a long time with victim
• may escalate over time as experience builds his confidence 
• attacks near his home/work, typically walks to crime scene

7 - 15 days

• low self-esteem
• underachiever
• non-athletic
• usually single
• low educational level
• if he dates, she is significantly younger
• usually white
• lives within walking distance of first rapes
• nocturnal
• nuisance sex offenses (scatophilia, exhibitionism, voyeurism)
• loner
• menial job
• older model car

• less common, more violent
• profile fits many date rapists
• impulsive
• wants to dominate 

moderate

• asserting & expressing his manhood through rape
• wants to hurt ♀ 

• often verbally abusive
• typically uses a "con" approach with victims
• victim is his age or close
• normally attacks in early evening
• attacks away from his home/work
• rips/tears off victim's clothing (very important detail to this profile)
• multiple assaults (oral + vaginal + anal, for example) in same attack
• often meets victim in a bar
• he's probably a regular at the bar; other regulars know him and that he preys on ♀ 

• macho
• married/divorced, may have serial marriages
• attacks are sporadic
• flashy dresser
• car reflects his image
• goes to singles' bars, drinks what is popular 
• ♂-oriented job
• self-centered
• arrest background may = disturbance, resisting arrest
• may escalate violence over time or during a single attack

20 - 25 days

• even less common than Power Assertive type
• excessive violence 
• enraged
• hard to catch
• hates ♀ 
• impulsive
• has suffered real or perceived insult from an important ♀ 

• excessive
• brutal
• victim more likely to suffer physical injuries 

• he is angry
• punishes & degrades ♀ in order to act out his anger

• spontaneous crime
• still planned but usually unknown victim
• opportunistic
• verbally, physically & sexually abusive
• uses blitz approach
• spends short time with victim but she will be injured
• victim is his age or older
• may select symbolic victims, but is opportunistic in victim selection
• attacks are episodic - not very predictable but occur at any time, whenever he is triggered
• often drinks/drugs before attack 

• explosive temper, explosive personality
• substance abuse quite common
• impulsive
• lone wolf, but not a loner - comfortable alone but has some friends
• very self-centered, but not inadequate
• con man
• action-oriented "manly" job
• often involved in team sports
• attacks at any time of day or night
• rents home
• car is commensurate with status but usually very nice and well-maintained
• probably married before
• arrest history may = aggravated assault, domestic violence 

6 - 12 months

• least frequent, most rare, most violent, most dangerous
• hard to catch
• ritualistic
• carries rape toolkit
• rape often happens after victim is dead 
• frequently rapes with instruments 

off-the-charts brutal

• total domination & control
• physical & emotional pain to victim
• true sexual sadist 

• premeditated assaults
• detailed plan - makes him hard to catch
• carries rape toolkit
• plans everything but the victim
• victim of opportunity (usually)
• "con" approach
• selfish & brutal
• dramatic attitude change - victim says "... like I was with two people" - goes from warm, kind -> cold & brutal when victim is in his grasp
• keeps victims for hours or days
• records his activities
• sexual experimentation level ranges from none to a great deal
• uses instruments & devices
• sexual bondage/captivity
• victims ages vary
• impulsive attack pattern but actual attacks are ritualistic
• cuts victims' clothing off with knives or scissors - reflects control 

• often has a traveling job
• white male
• good family man, model citizen, asset to the community
• nobody ever believes it could be him
• outdoorsman
• gun & knife enthusiast/collector
• may collect medieval torture devices/information, etc.
• detective magazines are his porn
• no arrest record
• loves to drive because it gives him a feeling of power & control 
• often a college grad; may be a professional
• above average intelligence
• likes big dogs
• late 30s
• attacks because he is bored with the norm
• his fantasies are more bizarre & brutal 
• often lives 2 separate lives: 1 normal, 1 bizarre
• complete separation between his 2 lives
• lives in middle-class residential area
• knowledge of police work
• antisocial personality & planning/implementation make him difficult to apprehend
• tells his victims what he plans to do to them in detail 
• probably many, many more of them than we know about 

no apparent pattern

• Acute/Impact Phase
• Outward Adjustment Phase
• Depression Phase
• Integration & Resolution Phase 

• Phases may be experienced out of sequence
• Phases may be experienced more than once
• Life stage is a significant factor
• Victims who are younger, divorced/separated, or middle-aged experience more serious concerns about independence
• Resolution where she returns to pre-rape levels of functioning may never occur
• Effects of rape are suffered for at least one year
• Bulk of improvement occurs in first 3 months 

• immediately following the rape
• may last from a few hours to several days 
• sense of shock, unable to believe what she went through
• may experience anxiety, feelings of total loss of control, confusion, sense of unreality, guilt and shame, exhaustion, extreme fear sometimes bordering on panic
• physical symptoms: soreness - generalized or in area of assault, bruising, nausea, stomach pains, loss of apetite, vaginal discharge, itchy or burning sensation upon urination, oral irritation and throat infection, rectal bleeding and/or pain

• Appears to have adjusted
• Response to pressure from society to go on with her life
• Feels the same emotions as in the impact phase, but less intensity
• Experiences alienation, isolation, and depression
• May last for weeks or months
• Physical symptoms: headaches, stomach or gastrointestinal problems, dizziness, unintentional weight loss/gain, difficulty breathing, sexual dysfunction
• Emotional responses: moodiness, decreased concentration, crying, tension, sadness, decreased self-confidence and self-esteem
• feelings of being out of control
• embarrassment and humiliation
• desire for revenge

• Obsessive memories, low self-esteem, and fear
• May last for days or months
• Makes lifestyle changes: move, change jobs, change phone numbers, refuse to go out alone at night, change patterns of work/studying/socializing, may drop off your radar during this phase
• Behavioral changes and interpersonal problems: difficulty in relationships with partner, family, employer, friends

• Shifts blame & anger from self to rapist
• May also have anger toward criminal justice system, advocate, society, men
• Sense of resolution, able to put experience behind her & talk about it without intense feelings
• Returns to pre-rape levels of functioning
• "New normal"
• May last for months or years

• - looking for means of escape
• - plan to fight back
• - plan to remain calm so the rapist doesn't injure her

• - most common strategy, especially ♀ victims
• - stalling for time
• - trying to talk their way out of it
• - trying to get sympathy by saying they are sick or pregnant
• - flattery, joking, sarcasm, or verbal aggression
• - saying someone is coming soon
• - threatening revenge by a husband/father/boyfriend
• - These tactics can come back on the victim during investigation & prosecution.

• - Running away
• - Physical resistance
• - Screaming
• - May struggle up to the point of penetration, then stop to avoid further injury

• - many victims do all of this
• - focus on something else during the attack
• - concentrate on memorizing details
• - concentrate on advice they have been given about how to cope (be very aware of this when doing prevention work)
• - compliance
• - physiological responses - choking, gagging, nausea, vomiting, urinating, defecating, hyperventilating, losing consciousness - usually not intentional

• - Many victims don't because they fear escalation of violence - trust & validate victim's instincts! - this reaction is more common in victims with history of child sexual assault
• - Type of resistance used matches the type of force used by the assailant
• - Most likely to be used by victims threatened with weapons or where offender initially uses physical force
• - May experience less severe sexual abuse without suffering any greater injury than victims who do not resist physically
• - Rape completion is less likely with any kind of resistance
• - For reducing the probability of injury, non-physical forms of resistance are more effective than either no resistance or physical resistance; verbal resistance is least likely to result in injury.

• - This is the FREEZE response
• - Tonic immobility
• - - Unlearned state of profound motor inhibition elicited by high-fear situations
• - - Catatonic-like posture, cessation of vocalization, tremors, periods of eye closure, decrease in heart rate, increase in body temperature & respiration
• - - Predicted by experiences of childhood sexual victimization or other previous sexual victimization
• - Traumatic psychological infantilism - childlike affect
• - - Induced by terror & results in helplessness
• - - Makes victim appear friendly & cooperative
• - - Submits to offender to avoid being killed
• - - May be blamed by responders, family, or self

• - When victim feels anger as well as fright; usually reverts to submissive behavior
• - "Passive" resistance patterns
• - - Crying
• - - Slowness to obey commands
• - - Appearing they are unable to understand demands

• - Escaping from rapist
• - Freeing herself from where she has been left
• - Securing her location
• - Telling others of needs for help & safety
• - In cases of drug-facilitated rape or unconsciousness, determining what happened
• - - Will never know for sure what happened = added trauma

PTSD

• - Sexual assault has higher prevalence of PTSD than any other trauma
• - May be especially severe & long lasting when compared to victims of other types of trauma
• - Characteristics of the assault, assault severity, & victim-offender relationship are NOT predictors of PTSD or its severity
• - History of past trauma & childhood sexual assault ARE predictors of PTSD & its severity

• History of traumatic events
• History of childhood sexual abuse
• Tonic immobility
• First assault was as a minor/virgin
• Not being married
• Having less education
• Perceived poor/fair health status
• Perceived threat during the assault

• Behavioral self-blame
• - Should have done something differently
• - Characterological self-blame (This happened to me because I'm a bad person)
• - - May be exacerbated by religious belief or response of religious figures
• - Victims who experience negative reactions when they disclose are more likely to self-blame
• - Associated with greater distress, use of self-destructive coping strategies, increased symptoms, higher rates of PTSD, poorer long term recovery

• Blames external factors, such as society
• Most common
• May not be conducive to recovery - Higher levels of hostility, anxiety, and depressive symptoms 

• Minimizes seriousness and downplays violence
• Less likely to seek help or support
• Places additional stress on victim
• African American women have greater tendency 

• Tries to make sense of assault by explaining why it happened and why it happened to them; because there are no answers, this is self-retraumatizing
• Repeatedly reviews every detail or relives the event 

• Tries to forget
• Avoids cues
• May sleep excessively or stay very busy
• Greater levels of psychological distress & social adjustment problems
• Happens more frequently when victims have experienced negative reactions from others at disclosure or when they blame themselves
• Happens more frequently when self or others have expectations of quick recovery
• Higher incidence with survivors of child sexual abuse 

• Uses religious views to help make sense of and find meaning in assault
• May provide a social support network
• Report positive life changes, for those for whom religious coping is useful

• Irritable, nervous and anxious
• Greater feelings of fear and negative mood states
• Experience more physical symptoms
• Higher incidence in survivors of child sexual abuse 

• "Cocooning" - can be positive
• Withdraws and stays home
• Greater symptoms, including fear, depression and sexual dissatisfaction, greater distress
• Fewer survivors choose this option
• Survivors who blame themselves are most likely to withdraw 

• One of the most common strategies
• Home - locking doors, not opening door to strangers, putting bars on windows, moving
• Lifestyle changes - quitting drinking, being careful about where they go
• Results in lower symptom levels 

• Cry or express feelings
• Facilitates social support
• Promotes positive life change soon after assault
• Alleviates self-blame
• Results in fewer trauma symptoms 

• Most supportive: SANE nurses & sisters
• Least supportive/frequently confided: husbands & male relatives
• Rated men as supportive, but less supportive than women 

• Meditation
• Listening to music
• Baths
• Drawing
• Journaling - Some controversy; can retraumatize, probably depends on if it's a strategy the victim has used before or chooses rather than one that is pushed on her
• Fewer symptoms & better adjustment 

• Drug & alcohol abuse, smoking, binging & purging, laxative abuse, high risk sexual behavior, self-harm, suicide attempts
• Suicide attempts associated with oral & anal rape and with greater self-blame & guilt
• Greater risk for survivors of child sexual abuse
• Results in longer recovery and more psychological symptoms

• Appreciating life, being more assertive, reevaluating goals, strengthening relationships, being more cautious, taking better care of one's self, growing spiritually
• Does not mean the rape was positive
• These survivors are most likely to cope successfully 

• age
• life situation
• personality
• circumstances of the rape
• response of first responders - HUGELY important, maybe most important
• response from family & friends
• response of criminal justice system (Is the prosecutor victim-savvy?)
• her own attitudes & beliefs about rape - the more educated victims are about rape before it happens, the better they can respond
• cultural considerations

• Cognitive assessment/determining alternatives
• Verbal tactics
• Physical action 

• Coping strategies
• Physical resistance
• Immobilization
• "Passive" resistance 

• Immediate post-assault response
• PTSD
• Post-rape attribution 

• Minimization
• Cognitive coping/cognitive appraisal
• Avoidance
• Religious coping
• Nervous/anxious coping
• Withdrawal
• Taking precautions
• Expressive strategies
• Stress reduction strategies
• Self-destructive strategies
• Finding positive meaning