You Asked: What Can We Do to Stop Rape?

A reader asks what we can do to stop rape. This question is very important to me having spent nearly 20 years treating child and adolescent victims of sexual assault and abuse.  It's also timely because April is Sexual Assault Awareness and Prevention Month. And awareness is the first step in preventing rape.

Let's start with some basic facts and then look at prevention. Sexual assault is any type of sexual activity (including rape) in which the victim is forced, threatened, doesn't consent, or is not capable of giving consent. Regardless of the victim's statements or actions, it is sexual assault if she or he is too young, drunk, drugged, or mentally impaired to legally consent to sex.

According to the most comprehensive, representative survey in the United States--the National Violence Against Women Survey:

• 1 of every 6 women (17.6%) and 1 of every 33 men (3%) have been raped at some time in their lives.
• The majority of the victims were younger than 18 years old when they were raped (females - 54%; males - 71%).
• Most disturbingly, many victims were less than 12 years old when they were raped (girls - 21.6%; boys - 48%).
• Girls under the age of 12 were most likely to be victimized by relatives. The girls ages 12 to 17 were more likely to be victimized by intimates and acquaintances. Women were more likely to be raped by intimates.
• Boys and men are more likely to be raped by acquaintances at all ages.

There are three basic approaches to preventing rape. The most common places the burden on potential victims to protect themselves. Some of the safety precautions are the same as for other violent crimes: Keep doors and windows locked (at home and in the car); don't open the door or go somewhere with strangers; and don't walk alone in isolated places (daytime or night). Although these actions can help prevent stranger rapes, most sexual assaults (80%) are committed by someone the victim knows--a boyfriend or girlfriend, relative, friend or acquaintance.

The following tips from the National Child Traumatic Stress Network's "Preventing Acquaintance Rape-A Safety Guide for Teens" apply also to young adults:

• Expect respect and keep away from people who don’t show you respect.
• Be clear about your limits: let the other person know what you want and don’t want to do. You have the right to change your mind, to say “no,” or to agree to some sexual activities and not to others.
• Don’t allow a person to touch you if it makes you uncomfortable. If your limits are reached or you sense danger, speak your mind and act immediately. Make a scene if necessary.
• Avoid excessive drinking or drugs. They reduce your ability to think and communicate clearly. Being drunk or high does not give anyone permission to assault you.
• Pour your own beverage and keep it in sight. Date rape drugs can be put into drinks and are often undetectable.
• Don’t hang out in places that keep you isolated from others. Although you may feel you can take care of yourself, it is always wise to be careful.
• Trust your instincts. If you feel that a person is not trustworthy or a situation is unsafe, leave.
• Have a back-up plan. For example, if you’re going out to a party in a different neighborhood, make sure someone you trust knows where you’re going. Have a person you can call to come and get you if you need to leave without your original ride.

A second prevention approach is to reach teen boys and young men before they commit rape. Men Can Stop Rape is one organization dedicated to this effort. Their program, Men of Strength (MOST) Club, is considered the premier primary prevention program for male youth in the country. It provides high school age and college age young men with a structured and supportive space to learn about healthy masculinity and redefine male strength.

The third approach is through law enforcement. Unfortunately, only 39% of rapes and sexual assaults are ever reported to the police. Partly due to the difficulty of investigating and prosecuting these crimes, only 16% of reports result in a perpetrator serving time in prison. Factoring in unreported rapes, only 6% of rapists end up in prison. The rest are free to repeat their crimes. One way to increase convictions is for more police and prosecutors to receive specialized training in sex crimes. Media attention and community pressure can help push local authorities into pursuing this training if they have not already done so.

So what can you do? Continue to educate yourself. Help raise awareness. Teach potential victims ways to protect themselves. Educate potential perpetrators through men's antiviolence programs. If you are a parent, talk to your children and teens about safety and healthy dating relationships. Encourage victims to report rape, and support them through the difficult process of investigation and prosecution. Donate time and money to your local rape crisis/sexual assault center--most are under-funded and under-staffed. (To find a center in your area, see RAINN's listing of state coalitions against sexual assault.) If you are a college student, get involved by supporting (or starting) a campus program to help victims and raise awareness among students.

To start raising awareness, watch the following video from RAINN and then e-mail it to everyone you know that could benefit. You can also link to it or embed it on your blog or website.

You Asked: What Are the Effects of Rape?

There are a wide range of short-term and long-term psychological effects that an individual victim may experience. The nature of the assault, use of a weapon, threats, violence, serious physical injuries, and relationship to the offender are some of the factors that can differentially affect the impact of rape on a particular victim. Those with a previous history of sexual abuse or other trauma are likely to be more severely affected by rape.

The immediate effects a victim may experience include shock, confusion, numbness, fear, anger, withdrawal, self-blame, guilt, shame, and denial. In the following weeks, victims often experience intense and unpredictable emotions, nightmares, flashbacks, difficulty sleeping, problems concentrating, feeling unsafe, and isolating from family and friends. Some victims may have great difficulty functioning in their daily life. Others cope by blocking their memories and feelings. Many cling to a semblance of normality as a way to deny the impact of their experience.

In the months following a rape, victims often have symptoms of depression or traumatic stress. They are more likely to abuse alcohol or drugs to control their symptoms. Nearly one-third have thoughts of suicide, and approximately 17% actually attempt suicide. Thirty-percent of victims will go on to develop Major Depressive or Post-traumatic Stress Disorders in their lifetime. Long-term negative effects on sexuality and the ability to form or maintain trusting relationships are common.

You may have noticed I have avoided gender pronouns. Although we most often think of females as rape victims, males are also victimized (estimates range from 10%- 20%). The effects on male victims are similar to those on female victims, but they are more likely to experience intense anger and aggression. They are also less likely to tell anyone about their experience or to seek help. Because the vast majority of offenders are men, it is not uncommon for male victims to question their own sexual orientation after the event.

It is essential for rape victims to seek help from mental health professionals with specialized training and experience. Rape crisis centers throughout the U.S. offer immediate support and counseling to help victims recover. You can search for a center in your community through RAINN (Rape, Abuse & Incest National Network). You can also call their hotline 1.800.656.HOPE, or speak to someone online for information and support. The following video explains how the hotlines work and the kind of help available at rape crisis centers.

You Asked: Depression - Thyroid or Hormonal Changes?

A reader wants to know if depression could be caused by undetected thyroid or hormonal changes. The short answer is yes. Hypothyroidism (an underactive thyroid gland), hyperthyroidism (an overactive thyroid gland), and adrenal insufficiency (a dysfunctional adrenal gland) are hormone disorders that can cause symptoms of depression. These illnesses can be detected by simple tests performed by your child's pediatrician.

Other medical conditions that may be associated with depressive symptoms include metabolic illness, anemia, seizure disorder, acquired immunodeficiency syndrome, Addison's disease, post-concussion, tuberculosis, diabetes, brain tumor, and chronic fatigue syndrome. Medications that can cause depression include antihypertensives, barbituates, corticosteroids, oral contraceptives, and albuterol. Green-Hernandez, C., Singleton, J. K., & Aronzon, D.Z. (2001). Primary care pediatrics. Philadephia: Lippincott, Williams & Wilkins, pg 314.

Hormonal changes at puberty have been linked to an increase in depression in adolescents as compared to children. There is little difference in the rates of depression between boys and girls prior to puberty, but among teenagers, twice as many girls as boys become depressed. It is unclear why there is such a significant gender difference. Many research studies show inconsistent results for hormone levels, early or late onset of puberty, psychosocial differences, and body image issues as possible causes. One explanation could be that hormonal changes only affect girls with a genetic predisposition for depression. Gotlib, I. H. & Hammen, C. L. (Eds.),2008. Handbook of depression (2nd ed.). New York: Guilford Press, pgs 388-389.