Sexual Assault And Its Mental health Consequences By Adeoye Oyewole
Sexual assault is an act of violence that is, by definition, against the victim’s will. The victim is forced to submit to genital, oral and/or anal sexual acts and often due to aggression, abuse and degradation. The attacker controls the situation by the use of physical force, threats of harm and intimidation. The victim fears she is going to be killed or injured and feels that survival is dependent on compliance and submission to the offender’s demands.
Sexual assault is an emotionally charged issue with medical, social, political and legal undertones. Many definitions abound, depending on the circumstance and context of the assault. The terms childhood sexual abuse and adulthood sexual violence, for example, are based on definitions developed by the American Medical Association. Childhood sexual abuse consists of contact abuse ranging from fondling to rape and non-contact abuse, such as modeling inappropriate sexual behavior, forced involvement in child pornography or indiscriminate exposure of the genitals. Adulthood sexual violence includes contact and non-contact acts performed without the survivors’ consent.
Sexual violence is defined as completed or attempted contact between the penis and the vulva or the penis and the anus involving contraction; contact between the mouth and the penis, vulva or anus; penetration of the anus or genital opening; and intentional touching of the genitalia, anus, groin, breast, inner thigh or buttocks. Non-contact acts include indecent exposure of the genitalia, verbal and behavioral sexual harassment. These acts are considered sexual violence, if they are non-consensual or committed against someone that is unable to provide consent.
There are many different terms for sexual violence, but I prefer sexual trauma, which refers to one or multiple sexual violations that invoke significant mental distress. This term is recommended and used by many clinicians and advocates in response to the observation that some victims do not label their experiences as assault due to the familiarity with the perpetrator or the absence of force.
The sexual trauma designation is apt because it considers the infringement of the victim’s psychological space and its consequences. This paradigm broadens the scope of definition of sexual assault as it interrogates the impact on the psyche much beyond the physical observable dramas. It is in this context that rape is deemed possible within the context of marriage.
The object of concern here is consent, which definitely must have been involved at the inception of marital relationship as a statutory requirement but equally crucial in the dynamic living out of the contracted relationship.
Consent in the context of mental health and possibly in the eye of the law must be dynamic, since it provides the psychological visa for a partner to explore the body of the giver within a consensual framework that insulates the partner from mental distress. This paradigm actually overrules a lot of our draconian, primitive, cultural and religious values as it guarantees mental well-being.
Sexual assault is not only a physical experience, but it also has concomitant psychological consequences. Survivals of childhood sexual trauma are at high risk of post-traumatic stress disorder characterised by intense fear, helplessness, horror, reoccurring recollections or dreams of the event, persistent avoidance of all things associated with the trauma, lack of responsiveness and increased alertness to perceived threats. They are also more likely to suffer depression, suicide, drug abuse and eating disorders.
Adult survivors of childhood sexual abuse report problems with low sexual interest and few close relationships. In other cases, some survivors display high risk sexual behaviors (e.g. promiscuity) that may be attributed in part to modeling some of the behaviors shaped earlier in life by the perpetrator. Such folks adopt maladaptive coping mechanisms to induce changes in consciousness and memory, thereby producing perceptions that one is living in a dream or a movie. These experiences are capable of impairing abilities to work of socialise.
Extreme experiences of victimisation are also associated with symptoms of borderline personality disorder characterised by enduring patterns of instability in relationships, goals, values and mood; non-fatal suicidal behaviour and suicidal threats and other harmful impulsive behaviours. Other forms of personality disorders may be distinguished by enduring patternsof suspiciousness, grandiosity and morbid craving for admiration, social inhibition and feelings of inadequacy or submissive and clingy behavior.
Victims of adult sexual trauma are vulnerable to immediate distress, fear, anxiety and confusion. They also experience emotional detachment, flashbacks and sleeping problems. Some develop depressive illness, physical symptoms without medical conditions, severe preoccupations with physical appearances, sexual dysfunction and extreme body piercing and tattooing. Some may have deliberate self-harm and abuse illicit drugs.
Parents, mental health workers, nongovernmental organisations and other stakeholders should provide platforms for the referral and care of victims as we encourage disclosures reduce stigma and raise awareness of available interventions for victims. Parents also must be vigilant to protect children from sexual victimisation. By Adeoye Oyewole Consultant Psychiatrist adeoyewole2000@yahoo.com
