THE PSYCHOLOGICAL IMPACT
OF SEXUAL ASSAULT
The medical and psychological consequences of sexual assault are wideranging. These may include physical injury, sexually transmitted diseases, risk of pregnancy, gynaecological trauma, medically explained and unexplained somatic symptoms, chronic illness, emotional disturbance, sexual dysfunction, suicide, and substance abuse (Koss and Harvey, 1991; Golding, 1994). While the immediate concern for the person who has been sexually assaulted may be the treatment of any physical injury (and finding evidence of the latter will be a focus for the forensic medical examiner to prove to courts that an assault has occurred; see Chapter 11), the psychological injuries are those that last. With high prevalence rates (see Chapter 1), it is possible to speculate that large numbers of women and men may have unresolved emotional difficulties related to histories of sexual assault. A history of sexual victimization is associated with overall increased health and medical system utilization (Koss et al., 1990). In those sexual assault survivors who do present to emergency clinics, follow-up rates are very low (Holmes et al., 1998). However, since the majority may never access any professional care (with sexual assault being the explicit presenting issue), a major neglected area of understanding is of the particular resilience individuals may demonstrate in coping with trauma in the aftermath of sexual assault. This chapter will provide an overview of the common affective, cognitive, and behavioural responses to sexual assault. The impact of ongoing stressors, vulnerability history, and assault-related variables that may affect post-assault psychological response will also be considered.