Challenging Dogma


...Using social sciences to improve the practice of public health

Monday, April 30, 2007

Treating the Victims of Sexual Assault at the University Level: Why Are We Failing to Reach Them? – Alexis Maule

The reported incidence of sexual assault perpetrated against women increases from ages 14-24 and peaks during the ages normally spent in college, 18-24. In fact, when the National Longitudinal Study of Adolescent Health conducted a study, “69.8% of college women had experienced at least 1 instance of sexual violence from age 14 through the fourth year of college” (1). There have been fairly recent policy changes at the university level to address the widespread issue of sexual assault. Throughout the 1990s, Congress amended the Student-Right-to-Know and Campus Security Act to expand the basic rights of all sexual assault victims and put an increased emphasis on reporting these crimes on campus (2). However, I believe that the sexual assault and domestic violence victim treatment programs offered in the university setting fail to reach the majority of the population they are targeting because these programs are founded a few basic behavioral theories that unsuccessfully explain the behavior and perceptions of the victim.

College women are already at increased risk for assaults because college is “a time characterized by greater independence and opportunities to engage in risk behavior” (3). Officials in the field of public health should strive to reach out to these women and to also address the health and well-being of the victims of assaults. We must improve the victim treatment programs to care for the immediate physical and mental problems caused by sexual victimization and to help these victims avoid future poor health outcomes. Being the victim of a sexual crime has recently been linked to an increased risk of poor health outcomes including: obesity, substance abuse, risky behavior, and suicide (4).

Shortcomings of the Theory of Reasoned Action

I think the first reason sexual assault victim treatment programs at local universities, specifically at BU, do not work is because their main focus is on treating the victim after the crime occurs. I believe that this approach uses the Theory of Reasoned Action (5). It assumes that victims of crimes will act reasonably and contact the proper authorities after the crime occurs. However, I think that this theory fails to address one important fact about sexual/domestic violent crimes; multitudes of victims do not report the assault or the abuse, so these programs are unable to reach these people. These programs fail because many victims go silent after the crime occurs. According to data from the National Crime Victimization Survey in 2002, only slightly more than 50% of victims of sexual assault reported the crime to the police (2). To address this issue, I think these programs need to understand their target clientele and the reasons why these victims live in silence.

Violence as a Social Norm

Sexual victimization has been defined as “an event in which one person attempts to obtain a sexual behavior from another individual against her or his wishes, using some sort of physical and/or psychological coercion” (2). In many, but not all instances this definition is understood and socially accepted. When reaching out to victims of sexual crimes, these programs assume that there is a strict social norm in place, which tells the victims of these assaults what constitutes as violence and what does not. However, the perceived amount of violence a person experiences or is witness to can be different across age groups and across backgrounds (1).

What may seem like an act of violence worthy of report to one person may seem like normal behavior to another person. In the case of the latter person, their social norm has shifted, so that more and more extreme acts of violence become tolerable or acceptable and they may neglect reporting any act of sexual violence imposed on them. Sexual assault victim treatment programs need to recognize these shifts in social norms, which largely depend on the experiences a person has as a child or adolescent, and they need to figure out ways to reach out to these target groups because many times it is these people who are at the highest risk of being victims of sexual assault/violence. People who grow up with a greater “lifetime community violence exposure” are more likely accept violence as a social norm, and furthermore, it makes a person more likely to accept violence in a relationship (whether it is an intimate partner or a friend) (3). Unfortunately, carrying past experiences with violence into future situations is especially true for women. Women who witnessed or experienced violence as children or as adolescents are less likely to seek help when in a sexually abusive situation as adults (6).

Remaining Silent

The main motivation for writing this paper came from an article reporting the sexual assault statistics for the Allston/Brighton area. It stated that 36 sexual assaults were reported in these neighborhoods in 2006. Of those 36 assaults, 35 of the victims knew their attacker. In another study conducted specifically at the university level, 95% of the sexual assault offenders were identified by the victims as boyfriends, friends, or casual acquaintances (1). This presents a huge obstacle when encouraging victims to report the crime and utilize treatment resources. Because the victims are personally linked to the majority of their attackers this may intimidate victims to report the crime or they may feel like they somehow caused their attack. Women, in particular, are more likely to assume the blame for the attack when they are being victimized. They also avoid reporting the incident to “minimize personal hurt and relational problems” (6).

Once again, I believe that the Theory of Reasoned Action is at fault. Many people, once they become victims, do not act in a reasonable way. Their self esteem and self worth have been severely damaged, especially when the assault comes from someone close to them. These victims fail to realize that the sexual victimization “cannot be justly attributed to the victim or the relationship” (6).

It is important to consider Maslow’s hierarchy of needs when talking about the relationship between self-esteem and the probability that a victim will report an assault. According to Maslow, the need for human beings to have their safety needs met comes directly after having their physiological needs met (7). Safety needs can be those related to having shelter or the protection of our body. When a person is sexually assaulted they may no longer feel that their need for safety is being met because their body has been violated. If a victim feels that their need for safety is not being met, they cannot move on to the other stages of need, particularly, the need for esteem, which includes self-esteem, self-confidence, and self-respect. As a result of the sexual victimization, a person will often feel unsafe in their environment and therefore less confident about their value as human being (7). A lack of self-confidence may prevent the victim from reporting the crime and a lack of self-esteem may cause a victim to deem themselves unworthy of treatment. Until the victims safety needs are being met, most likely through proper treatment, they will remain in a state of low self-esteem and low self-confidence.

Another reason for a lack of reporting may stem from other circumstances surrounding the crime. One study found that more than half of victims reported alcohol being involved in the situation before the crime occurred (8). This may also lead the victim to feel that their actions and behaviors somehow make them responsible for the assault. They may be embarrassed about the events surrounding the crime, so to keep from revealing their alcohol use they remain silent about the sexual victimization.

Furthermore, in a study conducted at Brown University, many of the women who admitted being a victim of sexual assault to the study investigators, listed “lack of confidentiality, fear, embarrassment and guilt” as several reasons for not reporting the crime to an official (2). The feelings expressed by the students not only prevented them from reporting the crime, but from seeking treatment as well. The study investigators compared the percentage of students who claimed to know about on-campus resources for victim treatment to the percentage who actually utilized the resources. They found that 90% of victims and 88% of non-victims knew about available on-campus resources for victims of sexual assault; however, only 22% of the victims utilized these resources after their crime occurred (2). Furthermore, the study investigators asked those students who reported no incidence of sexual victimization if they would use the on-campus resources if they became a victim of a sexual crime. Ninety-seven percent reported that they would (2).

It is evident that this percentage is vastly different than the percentage of students who actually sought treatment. This is direct evidence of the Theory of Reasoned Action failing because once these women became victims; they no longer acted reasonably and sought treatment.

Focusing on the Wrong Behavior Changes

Additionally, these programs fail is they focus on the behavior of victims and sometimes would-be victims and possible behavioral changes they can make to protect themselves. I think that these programs give good information and education, but I believe that the scope of the program is very limited. In a college setting, the majority of victims are female and the majority of attackers are male. I think that prevention programs should start focusing on educating and changing the behavior of males as well as females, otherwise they are reinforcing “themes of power inequality” and also the notion that a female’s behavior is somehow linked to the crime (6). The unequal footing women often have in relationships may be one of the primary underlying causes of female sexual victimization (9). Furthermore, these programs need to consider a person’s past experiences with violence and with relationships. The people we choose to surround ourselves with can depend heavily on our childhood experiences. Upon coming to college, students are surrounded by hundreds of new people and they seek out people similar to those who they have had relationships with in the past. People who have past experiences with violence are more likely to accept violence as a normal part of a relationship (6). Maybe rather than focusing on behavioral changes victims can make, we can shift the focus to building better, more communicative and more equal relationships with each other.

Sexual assault rates for women in late adolescence and college-age groups are two to three time higher than rates for women in other age groups. This epidemic of violence is widespread and affects women of all races and socioeconomic status. In fact, the National College Women Sexual Victimization study conduced in 1997 found that between one fifth and one quarter of college women will experience “a completed rape or attempted rate over the course of their college career” (2). Fortunately, it is not the case that victims do not know that treatment services exist; however, there are several factors that prevent women from reporting the victimization and seeking treatment. It is imperative that we bridge this gap and find new ways to effectively reach and treat these victims with compassion and understanding.

References

1. Smith, P., White, J., Holland, L. A Longitudinal Perspective on Dating Violence Among Adolescent and College-Age Women. American Journal of Public Health. 2003; 93:1104-1109.
2. Nasta, A., Shah, B., Brahmanandam, S., Richman, K., Wittels, K., Allsworth, J., Boardman, L. Sexual Victimization: Incidence, Knowledge and Resource Use among a Population of College Women. Journal of Pediatric Adolescent Gynecology. 2003; 18:91-96.
3. Brady, S. Lifetime Community Violence Exposure and Health Risk Behavior among Young Adults in College. Journal of Adolescent Health. 2006; 39:610-613.
4. Stein, MB., Barrett-Conner, E. Sexual Assault and Physical Health: Findings from a Population-based Study of Older Adults. Psychosomatic Medicine. 2000; 62(6):838-843.
5. Fishbein, M. A Theory of Reasoned Action: Some Applications and Implications. Nebraska Symposium on Motivation. 1980; 27:65-116.
6. Wekerle, C., Wolfe, D. Dating Violence in Mid-Adolescence: Theory, Significance, and Emerging Prevention Initiatives. Clinical Psychology Review. 1999; 19:435-455.
7. Vianna, LC., Bomfim, GF., and Chicone, G. Self-esteem of raped women. Rev Latino-am Enfermagem. 2006;14:695-701.
8. Abbey, A. Alcohol-related sexual assault: a common problem among college students. Journal of Studies on Alcohol. 2002; 14:118.
9. Matud, M. Dating Violence and Domestic Violence, Editorial. Journal of Adolescent Health. 2007; 40:295-297.

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