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University News | 10.15.2019

Campus Survey: Sexual Assault, Harassment Remain Serious Problems

Results from the second campus survey of sexual misconduct show that sexual assault and harassment remain serious problems at institutions of higher education nationwide..

On October 15, Harvard released the results of a  survey intended to estimate the prevalence of sexual assault and other sexual misconduct  among its undergraduate, graduate, and professional-school students. The survey, conducted during the spring of 2019, reached about 23,000 students, of whom 36.1 percent (about 8,300) responded. The data—echoing those from the 32 other private and public Association of American Universities (AAU) institutions that participated in this year’s survey— show that sexual assault and harassment are a serious problem. At Harvard, the prevalence of sexual assault (12.4 percent) was essentially unchanged since  a similar survey was conducted in 2015 . 

Among undergraduates, the vast majority of nonconsensual sexual contact is student to student (82.5 percent), takes place in on-campus housing (more than two-thirds overall, and 79.4 percent in incidents of penetration or sexual touching by physical force and/or inability to consent), and involves alcohol (75.6 percent). Rates among graduate students, who are less likely to live in on-campus housing, less likely to go out drinking with friends, and less likely to be single, are lower, but on-campus housing remains the modal location for sexual assault. Although the rates at which students disclose these incidents have been climbing rapidly (the rate of disclosure increased 56 percent in fiscal year 2018) the majority of students do  not  disclose incidents to the University, the survey showed—and the prevalence of nonconsensual sexual contact has been unaffected by rising disclosure rates. Among all AAU institutions that participated in both the 2015 and 2019 surveys, the prevalence of nonconsensual sexual contact has  risen  slightly overall.

The most significant change to the 2019 survey is that it introduces “incident level reporting” for cases of both sexual assault and sexual harassment: students who indicate that they have been victims of sexual assault, for example, are asked a series of additional questions, such as the nature of their relationship to the perpetrator, where they were during the time leading up to the incident, where they were when the incident occurred, the perpetrator’s relationship to the University, and whether they contacted any of the resources or support services available to them on campus (see table 4, above). With incident level reporting, the assertion made based on 2015 data that among undergraduates “about 15 percent of incidents took place in single-sex organizations that were not a fraternity or sorority”—final clubs—appears incorrect. Among Harvard College students, “on-campus social events” and “restaurants, bars and clubs” figure more prominently in both “leadup location” and “incident location,” behind on-campus housing.

Questions about sexual harassment, as opposed to assault, were changed in the 2019 survey, meaning that the data can’t be reliably compared to the data from the 2015. Harassment, however, remains a serious concern: 39.3 percent of respondents reported experiencing harassing behavior, and 17.7 percent reported that the harassment interfered with their academic or professional performance, limited their ability to participate in an academic program, or created an intimidating, hostile, or offensive social, academic, or work environment. As with allegations of assault, most harassment was perpetrated by other students.

Since the 2015 survey, Harvard has expanded its support services and educational outreach to its student communities. In 2016, the University hired Nicole Merhill as its Title IX officer, and specified that she spend 50 percent of her time designing prevention initiatives. Since then, 65,000 students, staff, and faculty members have participated in online training, and in-person training has been increasing rapidly, too (by 41 percent in the past year). Merhill has created two Title IX liaison groups, one for students and another for staff. And she has made a number of changes designed to increase the likelihood that students will disclose incidents of assault and harassment to University administrators, including expansion of its system of more than 50 Title IX coordinators. “Bystander” training, another initiative, seeks to increase the likelihood that students, faculty and staff will intervene if they see behavior that presages sexual assault. Most recently, Merhill established an online  anonymous disclosure  tool in response to student concerns that reporting an incident might lead to their losing control over the ensuing process. The new tool is designed to allow University affiliates to communicate with the University Title IX Office without revealing their identity until they are ready.

Nevertheless, most students who reported an incident of sexual assault did NOT seek out aid, whether from University Health Services, the office of BGLTQ student life, the mental-health counselors, the Title IX office, the Office for Dispute Resolution, the office of sexual assault prevention and response, Harvard chaplains, or student peer supports. The principal reason students gave for not reporting an incident was that it wasn’t serious enough. However, a majority reported that they did speak with friends and family about the event.

In  written recommendations  to President Lawrence S. Bacow, deputy provost Peggy Newell and Cahners-Rabb professor of business administration Kathleen L. McGinn, co-chairs of the Harvard 2019 AAU Student Survey on Sexual Assault and Misconduct, wrote that:

Knowledge of support services and belief in the fairness of University processes for investigating reports of nonconsensual sexual contact and sexual harassment have both risen since 2015, but less than half of our students feel very or extremely knowledgeable about support services on campus and less than half of our students believe that the outcome of University processes related to reports of sexual misconduct will be fair. In spite of heightened attention to nonconsensual sexual contact and sexual harassment in society, in the media, and at Harvard, only a minority of students experiencing nonconsensual sexual contact or sexual harassment access any of the resources available on campus…. The steady and high rate of nonconsensual sexual contact experienced by Harvard students calls for a cultural change across our community. 

President Bacow, in a letter to the Harvard community , wrote that:

the data support the reality that sexual assault and sexual harassment remain a serious problem at Harvard, and at institutions of higher education across the country….We must do more to prevent sexual and gender-based harassment and assault, and to encourage people to come forward to share their experiences and their concerns with us. And we must not rest until every member of our community has confidence in their institution’s ability to support them. This responsibility starts with the University leadership, but we can only truly effect meaningful change with your ideas and your commitment….

“Initiatives like bystander training,” he continued, “send the message to students that sexual misconduct is not acceptable." He has therefore “asked the Title IX Office to oversee the expansion of more of these bystander intervention initiatives across the University.” But he noted that “A change in culture can only come about through shared efforts by the administration, faculty, staff, and students,” and he invited all members of the Harvard community to a conversation about the issues raised by the survey at the Science Center on October 17. 

“One of my highest priorities,” he concluded, “is to create a community in which all of us can do our best work. To achieve this, we must seek to enhance our policies and procedures, and build out new resources, that are marked by our humanity, and which remind us to care for one another. But most importantly, we must recognize that we all have a role to play in ensuring that each of us who calls Harvard home feels welcome, and safe.”

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4.4 Violence against Women: Rape and Sexual Assault

Learning objectives.

• Describe the extent of rape and sexual assault.
• Explain why rape and sexual assault occur.

Susan Griffin (1971, p. 26) began a classic essay on rape in 1971 with this startling statement: “I have never been free of the fear of rape. From a very early age I, like most women, have thought of rape as a part of my natural environment—something to be feared and prayed against like fire or lightning. I never asked why men raped; I simply thought it one of the many mysteries of human nature.”

When we consider interpersonal violence of all kinds—homicide, assault, robbery, and rape and sexual assault—men are more likely than women to be victims of violence. While true, this fact obscures another fact: Women are far more likely than men to be raped and sexually assaulted. They are also much more likely to be portrayed as victims of pornographic violence on the Internet and in videos, magazines, and other outlets. Finally, women are more likely than men to be victims of domestic violence , or violence between spouses and others with intimate relationships. The gendered nature of these acts against women distinguishes them from the violence men suffer. Violence is directed against men not because they are men per se, but because of anger, jealousy, and the sociological reasons discussed in Chapter 8 “Crime and Criminal Justice” ’s treatment of deviance and crime. But rape and sexual assault, domestic violence, and pornographic violence are directed against women precisely because they are women. These acts are thus an extreme manifestation of the gender inequality women face in other areas of life. We discuss rape and sexual assault here but will leave domestic violence for Chapter 10 “The Changing Family” and pornography for Chapter 9 “Sexual Behavior” .

The Extent and Context of Rape and Sexual Assault

Our knowledge about the extent and context of rape and reasons for it comes from three sources: the FBI Uniform Crime Reports (UCR) and the National Crime Victimization Survey (NCVS), both discussed in Chapter 8 “Crime and Criminal Justice” , and surveys of and interviews with women and men conducted by academic researchers. From these sources we have a fairly good if not perfect idea of how much rape occurs, the context in which it occurs, and the reasons for it. What do we know?

Up to one-third of US women experience a rape or sexual assault, including attempts, at least once in their lives.

Wikimedia Commons – public domain.

According to the UCR, which are compiled by the Federal Bureau of Investigation (FBI) from police reports, 88,767 reported rapes (including attempts, and defined as forced sexual intercourse) occurred in the United States in 2010 (Federal Bureau of Investigation, 2011). Because women often do not tell police they were raped, the NCVS, which involves survey interviews of thousands of people nationwide, probably yields a better estimate of rape; the NCVS also measures sexual assaults in addition to rape, while the UCR measures only rape. According to the NCVS, 188,380 rapes and sexual assaults occurred in 2010 (Truman, 2011). Other research indicates that up to one-third of US women will experience a rape or sexual assault, including attempts, at least once in their lives (Barkan, 2012). A study of a random sample of 420 Toronto women involving intensive interviews yielded an even higher figure: Two-thirds said they had experienced at least one rape or sexual assault, including attempts. The researchers, Melanie Randall and Lori Haskell (1995, p. 22), concluded that “it is more common than not for a woman to have an experience of sexual assault during their lifetime.”

Studies of college students also find a high amount of rape and sexual assault. About 20–30 percent of women students in anonymous surveys report being raped or sexually assaulted (including attempts), usually by a male student they knew beforehand (Fisher, Cullen, & Turner, 2000; Gross, Winslett, Roberts, & Gohm, 2006). Thus at a campus of 10,000 students of whom 5,000 are women, about 1,000–1,500 women will be raped or sexually assaulted over a period of four years, or about 10 per week in a four-year academic calendar. The Note 4.33 “People Making a Difference” box describes what one group of college students did to help reduce rape and sexual assault at their campus.

People Making a Difference

College Students Protest against Sexual Violence

Dickinson College is a small liberal-arts campus in the small town of Carlisle, Pennsylvania. But in the fight against sexual violence, it loomed huge in March 2011, when up to 150 students conducted a nonviolent occupation of the college’s administrative building for three days to protest rape and sexual assault on their campus. While they read, ate, and slept inside the building, more than 250 other students held rallies outside, with the total number of protesters easily exceeding one-tenth of Dickinson’s student enrollment. The protesters held signs that said “Stop the silence, our safety is more important than your reputation” and “I value my body, you should value my rights.” One student told a reporter, “This is a pervasive problem. Almost every student will tell you they know somebody who’s experienced sexual violence or have experienced it themselves.”

Feeling that college officials had not done enough to help protect Dickinson’s women students, the students occupying the administrative building called on the college to set up an improved emergency system for reporting sexual assaults, to revamp its judicial system’s treatment of sexual assault cases, to create a sexual violence prevention program, and to develop a new sexual misconduct policy.

Rather than having police or security guards take the students from the administrative building and even arrest them, Dickinson officials negotiated with the students and finally agreed to their demands. Upon hearing this good news, the occupying students left the building on a Saturday morning, suffering from a lack of sleep and showers but cheered that they had won their demands. A college public relations official applauded the protesters, saying they “have indelibly left their mark on the college. We’re all very proud of them.” On this small campus in a small town in Pennsylvania, a few hundred college students had made a difference.

Sources: Jerving, 2011; Pitz, 2011

The public image of rape is of the proverbial stranger attacking a woman in an alleyway. While such rapes do occur, most rapes actually happen between people who know each other. A wide body of research finds that 60–80 percent of all rapes and sexual assaults are committed by someone the woman knows, including husbands, ex-husbands, boyfriends, and ex-boyfriends, and only 20–35 percent by strangers (Barkan, 2012). A woman is thus two to four times more likely to be raped by someone she knows than by a stranger.

In 2011, sexual assaults of hotel housekeepers made major headlines after the head of the International Monetary Fund was arrested for allegedly sexually assaulting a hotel housekeeper in New York City; the charges were later dropped because the prosecution worried about the housekeeper’s credibility despite forensic evidence supporting her claim. Still, in the wake of the arrest, news stories reported that hotel housekeepers sometimes encounter male guests who commit sexual assault, make explicit comments, or expose themselves. A hotel security expert said in one news story, “These problems happen with some regularity. They’re not rare, but they’re not common either.” A housekeeper recalled in the same story an incident when she was vacuuming when a male guest appeared: “[He] reached to try to kiss me behind my ear. I dropped my vacuum, and then he grabbed my body at the waist, and he was holding me close. It was very scary.” She ran out of the room when the guest let her leave but did not call the police. A hotel workers union official said housekeepers often refused to report sexual assault and other incidents to the police because they were afraid they would not be believed or that they would get fired if they did so (Greenhouse, 2011, p. B1).

Explaining Rape and Sexual Assault

Sociological explanations of rape fall into cultural and structural categories similar to those presented earlier for sexual harassment. Various “rape myths” in our culture support the absurd notion that women somehow enjoy being raped, want to be raped, or are “asking for it” (Franiuk, Seefelt, & Vandello, 2008). One of the most famous scenes in movie history occurs in the classic film Gone with the Wind , when Rhett Butler carries a struggling Scarlett O’Hara up the stairs. She is struggling because she does not want to have sex with him. The next scene shows Scarlett waking up the next morning with a satisfied, loving look on her face. The not-so-subtle message is that she enjoyed being raped (or, to be more charitable to the film, was just playing hard to get).

A related cultural belief is that women somehow ask or deserve to be raped by the way they dress or behave. If she dresses attractively or walks into a bar by herself, she wants to have sex, and if a rape occurs, well, then, what did she expect? In the award-winning film The Accused , based on a true story, actress Jodie Foster plays a woman who was raped by several men on top of a pool table in a bar. The film recounts how members of the public questioned why she was in the bar by herself if she did not want to have sex and blamed her for being raped.

A third cultural belief is that a man who is sexually active with a lot of women is a stud and thus someone admired by his male peers. Although this belief is less common in this day of AIDS and other STDs, it is still with us. A man with multiple sex partners continues to be the source of envy among many of his peers. At a minimum, men are still the ones who have to “make the first move” and then continue making more moves. There is a thin line between being sexually assertive and sexually aggressive (Kassing, Beesley, & Frey, 2005).

These three cultural beliefs—that women enjoy being forced to have sex, that they ask or deserve to be raped, and that men should be sexually assertive or even aggressive—combine to produce a cultural recipe for rape. Although most men do not rape, the cultural beliefs and myths just described help account for the rapes that do occur. Recognizing this, the contemporary women’s movement began attacking these myths back in the 1970s, and the public is much more conscious of the true nature of rape than a generation ago. That said, much of the public still accepts these cultural beliefs and myths, and prosecutors continue to find it difficult to win jury convictions in rape trials unless the woman who was raped had suffered visible injuries, had not known the man who raped her, and/or was not dressed attractively (Levine, 2006).

Structural explanations for rape emphasize the power differences between women and men similar to those outlined earlier for sexual harassment. In societies that are male dominated, rape and other violence against women is a likely outcome, as they allow men to demonstrate and maintain their power over women. Supporting this view, studies of preindustrial societies and of the fifty states of the United States find that rape is more common in societies where women have less economic and political power (Baron & Straus, 1989; Sanday, 1981). Poverty is also a predictor of rape; although rape in the United States transcends social class boundaries, it does seem more common among poorer segments of the population than among wealthier segments, as is true for other types of violence (Truman & Rand, 2010). Scholars think the higher rape rates among the poor stem from poor men trying to prove their “masculinity” by taking out their economic frustration on women (Martin, Vieraitis, & Britto, 2006).

Key Takeaways

• Up to one-third of US women experience a rape or sexual assault, including attempts, in their lifetime.
• Rape and sexual assault result from a combination of structural and cultural factors. In states and nations where women are more unequal, rape rates tend to be higher.

For Your Review

• What evidence and reasoning indicate that rape and sexual assault are not just the result of psychological problems affecting the men who engage in these crimes?
• Write a brief essay in which you critically evaluate the cultural beliefs that contribute to rape and sexual assault.

Barkan, S. E. (2012). Criminology: A sociological understanding (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Baron, L., & Straus, M. A. (1989). Four theories of rape in American society: A state-level analysis . New Haven, CT: Yale University Press.

Federal Bureau of Investigation. (2011). Crime in the United States, 2010 . Washington, DC: Author.

Fisher, B. S., Cullen, F. T., & Turner, M. G. (2000). The sexual victimization of college women . Washington, DC: National Institute of Justice.

Franiuk, R., Seefelt, J., & Vandello, J. (2008). Prevalence of rape myths in headlines and their effects on attitudes toward rape. Sex Roles, 58 (11/12), 790–801.

Greenhouse, S. (2011, May 21). Sexual affronts a known hotel hazard. New York Times , p. B1.

Griffin, S. (1971, September). Rape: The all-American crime. Ramparts, 10 , 26–35.

Gross, A. M., Winslett, A., Roberts, M., & Gohm, C. L. (2006). An examination of sexual violence against college women. Violence Against Women, 12 , 288–300.

Jerving, S. (2011, March 4). Pennsylvania students protest against sexual violence and administrators respond. The Nation . Retrieved from http://www.thenation.com/blog/159037/pennsylvania-students-protests-against-sexual-violence-and-administrators-respond .

Kassing, L. R., Beesley, D., & Frey, L. L. (2005). Gender role conflict, homophobia, age, and education as predictors of male rape myth acceptance. Journal of Mental Health Counseling, 27 (4), 311–328.

Levine, K. L. (2006). The intimacy discount: Prosecutorial discretion, privacy, and equality in the statuory rape caseload. Emory Law Journal, 55 (4), 691–749.

Martin, K., Vieraitis, L. M., & Britto, S. (2006). Gender equality and women’s absolute status: A test of the feminist models of rape. Violence Against Women, 12 , 321–339.

Pitz, M. (2011, March 6). Dickinson College to change sexual assault policy after sit-in. Pittsburgh Post-Gazette . Retrieved from http://www.post-gazette.com/pg/11065/1130102-1130454.stm .

Randall, M., & Haskell, L. (1995). Sexual violence in women’s lives: Findings from the women’s safety project, a community-based survey. Violence Against Women, 1 , 6–31.

Sanday, P. R. (1981). The Socio-Cultural Context of Rape: A Cross-Cultural Study. Journal of Social Issues, 37 , 5–27.

Truman, J. L., & Rand, M. R. (2010). Criminal victimization, 2009 . Washington, DC: Bureau of Justice Statistics.

Social Problems Copyright © 2015 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Open Access

Peer-reviewed

Research Article

Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk

Contributed equally to this work with: Claude A. Mellins, Kate Walsh, Aaron L. Sarvet, Melanie Wall, Leigh Reardon, Jennifer S. Hirsch

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Division of Gender, Sexuality and Health, Departments of Psychiatry and Sociomedical Sciences, New York State Psychiatric Institute and Columbia University Medical Center, New York, New York, United States of America

Roles Conceptualization, Writing – original draft, Writing – review & editing

Affiliations Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, United States of America, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Roles Conceptualization, Formal analysis, Investigation, Visualization, Writing – review & editing

Affiliation Division of Biostatistics, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center, New York, New York, United States of America

Roles Conceptualization, Formal analysis, Investigation, Methodology, Visualization, Writing – review & editing

Affiliations Division of Biostatistics, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center, New York, New York, United States of America, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Roles Conceptualization, Investigation, Methodology, Writing – original draft, Writing – review & editing

¶ ‡ These authors also contributed equally to this work.

Affiliation Social Intervention Group, School of Social Work, Columbia University, New York, New York, United States of America

Roles Conceptualization, Investigation, Methodology, Writing – review & editing

Affiliation Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Roles Methodology, Writing – review & editing

Affiliation Department of Youth, Family, and Community Studies, Clemson University, Clemson, South Carolina, United States of America

Roles Investigation, Methodology, Writing – review & editing

Affiliation Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America

Roles Conceptualization, Writing – review & editing

Affiliation Department of Sociology, Columbia University, New York, New York, United States of America

Roles Data curation, Investigation, Methodology, Writing – review & editing

Roles Data curation, Investigation, Methodology

Roles Writing – original draft, Writing – review & editing

Roles Conceptualization, Data curation, Investigation, Methodology, Project administration, Writing – review & editing

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Writing – review & editing

• Claude A. Mellins, 
• Kate Walsh, 
• Aaron L. Sarvet, 
• Melanie Wall, 
• Louisa Gilbert, 
• John S. Santelli, 
• Martie Thompson, 
• Patrick A. Wilson, 
• Shamus Khan, 

• Published: November 8, 2017
• https://doi.org/10.1371/journal.pone.0186471
• Reader Comments

25 Jan 2018: The PLOS ONE Staff (2018) Correction: Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk. PLOS ONE 13(1): e0192129. https://doi.org/10.1371/journal.pone.0192129 View correction

Sexual assault on college campuses is a public health issue. However varying research methodologies (e.g., different sexual assault definitions, measures, assessment timeframes) and low response rates hamper efforts to define the scope of the problem. To illuminate the complexity of campus sexual assault, we collected survey data from a large population-based random sample of undergraduate students from Columbia University and Barnard College in New York City, using evidence based methods to maximize response rates and sample representativeness, and behaviorally specific measures of sexual assault to accurately capture victimization rates. This paper focuses on student experiences of different types of sexual assault victimization, as well as sociodemographic, social, and risk environment correlates. Descriptive statistics, chi-square tests, and logistic regression were used to estimate prevalences and test associations. Since college entry, 22% of students reported experiencing at least one incident of sexual assault (defined as sexualized touching, attempted penetration [oral, anal, vaginal, other], or completed penetration). Women and gender nonconforming students reported the highest rates (28% and 38%, respectively), although men also reported sexual assault (12.5%). Across types of assault and gender groups, incapacitation due to alcohol and drug use and/or other factors was the perpetration method reported most frequently (> 50%); physical force (particularly for completed penetration in women) and verbal coercion were also commonly reported. Factors associated with increased risk for sexual assault included non-heterosexual identity, difficulty paying for basic necessities, fraternity/sorority membership, participation in more casual sexual encounters (“hook ups”) vs. exclusive/monogamous or no sexual relationships, binge drinking, and experiencing sexual assault before college. High rates of re-victimization during college were reported across gender groups. Our study is consistent with prevalence findings previously reported. Variation in types of assault and methods of perpetration experienced across gender groups highlight the need to develop prevention strategies tailored to specific risk groups.

Citation: Mellins CA, Walsh K, Sarvet AL, Wall M, Gilbert L, Santelli JS, et al. (2017) Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk. PLoS ONE 12(11): e0186471. https://doi.org/10.1371/journal.pone.0186471

Editor: Hafiz T. A. Khan, University of West London, UNITED KINGDOM

Received: July 28, 2017; Accepted: October 2, 2017; Published: November 8, 2017

Copyright: © 2017 Mellins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data underlying the study cannot be made available, beyond the aggregated data that are included in the paper, because of concerns related to participant confidentiality. Sharing the individual-level survey data would violate the terms of our agreement with research participants, and the Columbia University Medical Center IRB has confirmed that the potential for deductive identification and the risk of loss of confidentiality is too great to share the data, even if de-identified.

Funding: This research was funded by Columbia University through a donation from the Levine Family. The funder (Levine Family) had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Recent estimates of sexual assault victimization among college students in the United States (US) are as high as 20–25% [ 1 – 3 ], prompting universities to enhance or develop policies and programs to prevent sexual assault. However, a 2016 review [ 4 ] highlights the variation in sexual assault prevalence estimates (1.8% to 34%) which likely can be attributed to methodological differences across studies, including varying sexual assault definitions, sampling methods, assessment timeframes, and target populations [ 4 ]. Such differences can hamper efforts to understand the scope of the problem. Moreover, while accurate estimates of prevalence are crucial for calling attention to the population-health burden of sexual assault, knowing more about risk factors is critical for determining resource allocation and developing effective programs and policies for prevention.

Reasons for the variation in prevalence estimates include different definitions of sexual assault and assessment methods. Under the rubric of sexual assault, researchers have investigated experiences ranging from sexual harassment at school or work, to unwanted touching, including fondling on the street or dance floor, to either unwanted/non-consensual attempts at oral, anal or vaginal sexual intercourse (attempted penetrative sex), or completed penetrative sex [ 3 , 5 – 7 ]. Some studies have focused on a composite variable of multiple forms of unwanted/non-consensual sexual contact [ 8 , 9 ] while others focus on a single behavior, such as completed rape [ 10 ]. Some studies focus on acts perpetrated by a single method (e.g. incapacitation due to alcohol and drug use or other factors) [ 11 ], while others include a range of methods (e.g., physical force, verbal coercion, and incapacitation) [ 12 – 15 ]. In general, studies that ask about a wide range of acts and use behaviorally specific questions about types of sexual assault and methods of perpetration have yielded more accurate estimates [ 16 ]. Behavioral specificity avoids the pitfall of participants using their own sexual assault definitions and does not require the respondent to identify as a victim or survivor, which may lead to underreporting [ 10 , 17 – 19 ].

Although an increasing number of studies have used behaviorally specific methods and examined prevalence and predictors of sexual assault [ 20 , 21 ], they typically have used convenience samples. Only a few published studies have used population-based surveys and achieved response rates sufficient to mitigate some of the concerns of sample response bias [ 4 ]. US federal agencies have urged universities to implement standardized “campus climate surveys” to assess the prevalence and reporting of sexual violence [ 22 ]. Although these surveys have emphasized behavioral specificity, many have yielded low response rates (e.g., 25%) [ 23 ], particularly among men [ 24 ], creating potential for response bias in the obtained data. Population-based probability samples with behavioral specificity, good response rates, sufficiently large samples to examine risk for specific subgroups (e.g., sexual minority students), and detailed information on personal, social, or contextual risk factors (e.g., alcohol use) [ 22 , 23 ] are needed to more accurately define prevalence and inform evidence-based sexual assault prevention programs.

Existing evidence suggests that most sexual assault incidents are perpetrated against women [ 25 ]; however, few studies have examined college men as survivors of assault [ 26 – 28 ]. Furthermore, our understanding of how sexual orientation and gender identity relate to risk for sexual assault is limited, despite indications that lesbian, gay, bisexual (LGB), and gender non-conforming (GNC) students are at high risk [ 29 – 31 ]. It is unclear if these groups are at higher risk for all types of sexual assault or if prevention programming should be tailored to address particular types of assault within these groups. Also, although women appear to be at highest risk for assault during freshman year [ 32 , 33 ], the dearth of studies with men or GNC students have limited conclusions about whether freshman year is also a risky period for them.

Additional factors associated with experiencing sexual assault in college students include being a racial/ethnic minority student (although there are mixed findings on race/ethnicity) [ 34 , 35 ], low financial status, and prior history of sexual assault [ 3 , 33 , 36 ]. Other risk factors include variables related to student social life, including being a freshman [ 24 ], participating in fraternities and sororities [ 19 , 37 , 38 ], binge drinking [ 1 , 39 ] and participating in “hook-up” culture [ 40 – 42 ]. Whether sexual assault is happening in the context of more casual, typically non-committal sexual relationships (“hook-ups”) [ 40 ] vs. steady intimate or monogamous relationships has important implications for prevention efforts.

To fill some of these knowledge gaps, we examined survey data collected from a large population-based random sample of undergraduate women, men, and GNC students at Columbia University (CU) and Barnard College (BC). The aims of this paper are to:

• Estimate the prevalence of types of sexual assault incidents involving a) sexualized touching, b) attempted penetrative (oral, anal or vaginal) sex, and c) completed penetrative sex since starting at CU/BC;
• Describe the methods of perpetration (e.g., incapacitation, physical force, verbal coercion) used; and
• Examine associations between key sociodemographic, social and romantic/sexual relationship factors and different types of sexual assault victimization, and how these associations differ by gender.

Materials and methods

This study used data from a population-representative survey that formed one component of the Sexual Health Initiative to Foster Transformation (SHIFT) study. SHIFT used mixed methods to examine risk and protective factors affecting sexual health and sexual violence among college undergraduates from two inter-related institutions, CU’s undergraduate schools (co-educational) and BC (women only), both located in New York City. SHIFT featured ethnographic research, the survey, and a daily diary study. Additionally, SHIFT focused on internal policy-translation work to inform institutionally-appropriate, multi-level approaches to prevention.

Participants

Survey participants were selected via stratified random sampling from the March 2016 population of 9,616 CU/BC undergraduate students ages 18–29 years. We utilized evidence-based methods to enhance response rates and sample representativeness [ 22 , 43 ]. Using administrative records of enrolled students, 2,500 students (2,000 from CU and 500 from BC) were invited via email to participate in a web-based survey. Of these 2,500 students, 1,671 (67%) consented to participate (see Procedures). Among those who consented to participate, 80.5% were from CU and 19.5% were from BC (see Table 1 below for demographic data on the CU/BC student population, the random sample of students contacted, the survey responders, and the current analytic sample).

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SHIFT employed multiple procedures to assure protection of students involved in our study; these procedures also improve scientific rigor. The study was approved by the Columbia University Medical Center Institutional Review Board and we obtained a federal Certificate of Confidentiality to legally protect our data from subpoena. SHIFT also obtained a University waiver from reporting on individual sexual assaults, as reporting would obviate student privacy and willingness to participate. Students were offered information about referrals to health and mental health resources during the consent process and at the end of the survey, and such information was available from SHIFT via other communication channels. Finally, in reporting data we suppressed data from tables where there were less than 3 subjects in any cell to avoid the possibility of deductive identification of an individual student [ 44 ].

SHIFT used principles of Community Based Participatory Research regarding ongoing dialogue with University stakeholders on study development and implementation to maximize the quality of data and impact of research findings [ 45 ]. This included weekly meetings between SHIFT investigators and an Undergraduate Advisory Board, consisting of 13–18 students, reflecting the undergraduate student body’s diversity in terms of gender, race/ethnicity, sexual orientation, year in school, and activities (e.g., fraternity/sorority membership). It also included regular meetings with an Institutional Advisory Board comprised of senior administrators, including CU’s Office of General Counsel, facilities, sexual violence response, student conduct, officials involved in gender-based misconduct concerns, athletics, a chaplain, mental health and counseling, residential life, student health, and student life.

Following both the Undergraduate Advisory Board’s recommendations and Dillman’s Tailored Design Method for maximizing survey response rates [ 43 ], multiple methods were used to advertise and recruit students. These included: a) email messages, both to generate interest and remind students who had been selected to participate, crafted to resonate with diverse student motives for participation (e.g., interest in sexual assault, compensation, community spirit, and achieving higher response rates than surveys at peer institutions), b) posting flyers, c) holding “study breaks,” in which students were given snacks and drinks, and d) tabling in public areas on campus.

Participants used a unique link to access the survey either at our on-campus research office where computers and snacks were provided (16% of participants) or at a location of their choosing (84% of participants) from March-May, 2016. Before beginning the survey, participants were asked to provide informed consent on an electronic form describing the study, confidentiality, compensation for time and effort, data handling procedures, and the right to refuse to answer any question. Students who completed the survey received $40 in compensation, given in cash to those who completed the survey in our on-campus research office or as an electronic gift card if completed elsewhere. Students were also entered into a lottery to win additional $200 electronic gift cards. This compensation was established based on feedback from student and institutional advisors and reviewed by our Institutional Review Board. It was judged to be sufficient to promote participation, and help ensure that we captured a representative sample, including students who might otherwise have to choose between paid opportunities and participating in our survey, but not great enough to feel coercive for low resource students. This amount of compensation is in line with other similar studies [ 46 ]. On average, the survey took 35–40 minutes to complete.

The SHIFT survey included behaviorally-specific measures of different types of sexual assault, perpetrated by different methods, as well as measures of key sociodemographic, social and sexual relationship factors, and risk environment characteristics. The majority of instruments had been validated previously with college- age students. The survey was administered in English using Qualtrics ( www.qualtrics.com ), providing a secure platform for online data collection.

Sexual assault.

Sexual assault was assessed with a slightly modified version of the revised Sexual Experiences Survey [ 16 ], the most widely used measure of sexual assault victimization with very good psychometric properties including internal consistency and validity previously published [ 17 , 47 ]. The Sexual Experiences Survey employs behaviorally specific questions to improve accuracy [ 18 ]. The scale includes questions on type of assault, including sexualized touching without penetration (touching, kissing, fondling, grabbing in a sexual way), attempted but not completed penetrative assault (oral, vaginal, anal or other type of penetration; herein referred to as attempted penetrative assault) and completed penetrative assault (herein referred to as penetrative assault). We used most of the Sexual Experiences Survey as is. However, with strong urging from our Undergraduate Advisory Board, we made a modification, combining the questions about different types of penetration (oral, vaginal, etc.) rather than asking about each kind separately. In the Sexual Experiences Survey, for each type of assault there are six methods of perpetration. Two of the types reflect verbal coercion: 1) “Telling lies, threatening to end the relationship, threatening to spread rumors about me, making promises I knew were untrue, or continually verbally pressuring me after I said I didn’t want to” (herein referred to as “lying/threats”), and 2) “Showing displeasure, criticizing my sexuality or attractiveness, getting angry but not using physical force, after I said I didn’t want to” (herein referred to as “criticism”). The remaining types included use of physical force, threats of physical harm, or incapacitation (“Taking advantage when I couldn’t say no because I was either too drunk, passed out, asleep or otherwise incapacitated”), and other. For each incident of sexual assault, participants could endorse multiple methods of perpetration. Participants were also asked to report whether these experiences occurred: a) during the current academic year (this was a second modification to the Sexual Experiences Survey) and/or b) since enrollment but prior to the current academic year. For this paper, data for the two time periods were combined, reflecting the entire period since starting CU/BC. See Fig 1 for a replica of the questionnaire.

https://doi.org/10.1371/journal.pone.0186471.g001

Demographics.

Demographics included gender identity (male, female, trans-male/trans-female, gender queer/gender-non-conforming, other) [ 48 ], year in school (e.g., freshman, sophomore, junior, senior), age, US born (yes/no), lived in US less than five years (yes/no; proxy for recent international student status), transfer student (yes/no), low socioeconomic status (receipt of Pell grant-yes/no [need-based grants for low-income students, with eligibility dependent on family income]); how often participant has trouble paying for basic necessities (never, rarely, sometimes, often, all of the time), and race/ethnicity (non-Hispanic white, non-Hispanic-Asian, non-Hispanic black, Hispanic/Latin-x, other [other included: American Indian or Alaska Native, Native Hawaiian or Pacific Islander, More than one Race/Ethnicity, Other]). Gender was categorized as follows: female, male and GNC (students who responded to gender identity question as anything other than male or female).

Fraternity/Sorority.

Fraternity/sorority membership (ever participated) was assessed with one question from a school activities checklist (yes/no). We report on Greek life participation here to engage with the substantial attention this has received as a risk factor.

Problematic drinking.

Problematic drinking during the last year was assessed with the Alcohol Use Disorders Identification Test (AUDIT) [ 49 ], a widely used, well-validated standardized 10-item screening tool developed by the World Health Organization. Psychometrics have been established in numerous studies [ 50 – 52 ]. The AUDIT assesses alcohol consumption, drinking behaviors, and alcohol-related problems. Participants rate each question on a 5-point scale from 0 (never) to 4 (daily or almost daily) for possible scores ranging from 0 to 40. The range of AUDIT scores represents varying levels of risk: 0–7 (low), 8–15 (risky or hazardous), 16–19 (high-risk or harmful), and 20 or greater (high-risk). We also examined one AUDIT item on binge drinking, defined as having 6+ drinks on one occasion at least monthly [ 49 ].

Sexual orientation.

Sexual orientation was assessed with one question with the following response options (students could select all that applied): asexual, pansexual, bisexual, queer, heterosexual and homosexual, as well as other [ 53 , 54 ]. Students were categorized into four mutually exclusive groups for analyses: heterosexual, bisexual, homosexual, and other which included asexual, pansexual, queer, or another identity not listed. Non-heterosexual students who indicated more than one orientation were assigned hierarchically to bisexual, homosexual, then other.

Romantic/sexual relationships.

Romantic/sexual relationships since enrollment at CU/BC were assessed with one question. Response choices included: none, steady or serious relationship, exclusive or monogamous relationship, hook-up-one time, and ongoing hook-up or friends with benefits. Students defined “hookup” for themselves. Students could check all that applied. This variable was trichotomized: at least one hook-up, only steady or exclusive/monogamous relationships, and no romantic/sexual relationships.

Pre-college sexual assault.

Students also were asked one yes/no question on whether they had experienced any unwanted sexual contact prior to enrolling at CU/BC.

Data analysis

To assess the representativeness of the sample, the distribution of demographic variables based on administrative records from CU and BC for the total University undergraduate population were compared to the random sample of students contacted, the survey responders, and the current analytic sample, which consists of students that responded to the questions about sexual assault. Demographics for survey responders are based on self-report from the survey. Cramer’s V effect size was used to assess the magnitude of the differences in demographic distributions between the CU/BC population and respondent sample where smaller values (i.e. Cramer’s V <0.10) indicate strong similarity [ 55 ].

Analyses were performed on each type of sexual assault as well as a combined “Any type of sexual assault” variable: yes/no experienced sexualized touching, attempted penetrative assault, and/or penetrative assault since CU/BC. Prevalence of each type of sexual assault was calculated by gender and year in school, with chi-square tests of difference used to compare prevalence between genders across each year in school versus freshman year. The total number of incidents of assault and the mean, median and standard deviation for number of incidents of assault per person reporting at least one assault were summarized. Among individuals who experienced any type of sexual assault, the proportions that experienced a particular method of perpetration (e.g. incapacitation, physical force) were calculated by type of sexual assault. Chi-square tests compared proportions between males and females for each perpetration method. The associations of each key correlate with the odds of experiencing any sexual assault were calculated and tested using logistic regression stratified by male/female gender. In addition, a multinomial regression with hierarchical categories (no assault, sexualized touching only, attempted penetrative assault [not completed], and penetrative assault [completed]) as the outcome was performed to examine if associations differed by type of sexual assault. To adjust for the fact that the sample comes from a finite population (i.e. CU/BC N = 5,765 women; N = 3,851 men), a standard finite population correction was implemented for standard error estimation using SAS Proc Surveylogistic. Given the low sample size of GNC students, they were excluded from some analyses. All analyses were conducted using SAS (v. 9.4).

Descriptive statistics

Table 1 presents demographic data on the full University, the randomly selected sample, the respondents and the analytic sample for this paper. Among students who consented to the survey (n = 1,671), 46 stopped the survey before the sexual assault questions and 33 refused to answer them resulting in an analytic sample of n = 1,592 (95% completion among responders). Demographic characteristics (i.e. gender [male, female], age, race/ethnicity, year in school, international status, and economic need [Pell grant status]) of the respondent sample were very similar (Cramer’s V effect size differences all <0.10 [ 55 ]) to the full CU/BC population ( Table 1 ) indicating that the responder and final analytic samples were representative of the student body population.

The analytic sample included 58% women, 40% men, and 2% GNC students (4 students refused to identify their gender) and was distributed evenly by year in school with most (92%) between18-23 years of age. Self-reported race/ethnicity was 43% white non-Hispanic, 23% Asian, 15% Hispanic/Latino, and 8% black non-Hispanic; 13% were transfer students, and the majority of the sample was born in the US (76%). Twenty-three percent of participants received Pell grants and 51% of students acknowledged at least sometimes having difficulty paying for basic necessities.

The majority of women (79%) and men (85%) identified as heterosexual. In terms of romantic/sexual relationships since starting CU/BC, 30.0% of women and 21.6% of men reported no relationships, 21.0% of women and 22.6% of men reported only steady/exclusive relationships with no hookups, and 49.0% of women and 55.7% of men reported at least one hook-up. Finally, 25.5% of women, 9.4% of men, and 47.0% of GNC students reported pre-college sexual assault.

Aim 1: Prevalence of sexual assault victimization at CU/BC

Overall rates by gender and school year..

Since starting CU/BC, 22.0% (350/1,592) of students reported experiencing at least one incident of any sexual assault across the three types (sexualized touching, attempted penetrative assault, and penetrative assault). Table 2 presents data on types of assault by gender and year in school. Women were over twice as likely as men to report any sexual assault (28.1% vs 12.5%). There was evidence of cumulative risk for experiencing sexual assault among women over four years of college, so that by junior and senior year, respectively, 29.7% and 36.4% of women reported experiencing any sexual assault, compared to 21.0% of freshman women who had only one year of possible exposure (p < .05). However, one-fifth (21.0%) of women who took the survey as freshman had experienced unwanted sexual contact, compared to 36.4% over 3+ years (seniors), suggesting that as others have found, the risk of assault is highest in freshman year.

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Among men, one in eight indicated that they had been sexually assaulted since starting CU. Similar to women, the risk for sexual assault among men accumulated over the four years of college, with 15.6% of seniors vs 9.9% of freshman reporting a sexual assault since entering CU, although this difference was not statistically significant.

Although the numbers were small, GNC students reported the highest prevalence of sexual assault since starting CU/BC (38.5%; 10/26). Numbers were too small (n<3) to present stratified by year in school (see Table 2 ).

Types of sexual assault by gender ( Table 2 ).

The most prevalent form of sexual assault was sexualized touching; rates for women (23.6%) and GNC students (38.5%) were significantly higher than rates for men (11.0%; p < .05). Prevalence of attempted penetrative assault and penetrative assault were about half that of sexualized touching. Compared to men, women were three times as likely to report attempted penetrative assault (11.1% vs 3.8%) and over twice as likely to experience penetrative assault (13.6% vs 5.2%). Among GNC students, the majority reporting sexualized touching, with rates of the other two types too small to report.

Experiencing multiple sexual assaults ( Fig 2 ; S1 Table ).

Students could report multiple types of sexual assault incidents (i.e. sexualized touching, attempted penetrative, and penetrative assault) as well as multiple incidents experienced of each type. Overall, students reported a total of 1,007 incidents of sexual assault experienced since starting CU/BC. For the 350 students who indicated any sexual assault, the median number of incidents experienced was 3.

https://doi.org/10.1371/journal.pone.0186471.g002

Among the 350 students reporting any sexual assault, Fig 2 presents different combinations of sexual assault experienced by students since CU/BC. Most prevalent, 38.0% reported experiencing only sexualized touching; 19.0% reported both sexualized touching and penetrative assault incidents; 17.0% experienced all three types of assault; and 12.0% sexualized touching and attempted penetrative assault.

Aim 2: Methods of perpetration (lying/threats, criticism, incapacitation, physical force, threats of harm, and other) by gender ( Table 3 )

Across types of assault, incapacitation was the method of perpetration reported most frequently (> 50%) in both men and women. For both women and men, approximately two-thirds of all penetrative assaults and about half of sexualized touching and attempted penetrative assaults involved incapacitation.

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Physical force was reported significantly more frequently by women than men (34.6% vs 12.7%) for any sexual assault. More specifically, compared to men, women were three times more likely to experience sexualized touching via physical force (32.1% vs. 10.0%), and six times more likely to experience penetrative assaults via physical force (33.3% vs 6.1%).

Lastly, a sizeable number of respondents reported verbal coercion (ranging from 21.0% to over 40.0% depending on type of assault). Criticism was cited by women at rates similar to physical force for both sexualized touching and penetrative assaults. Among men, both verbal coercion methods were cited most frequently after incapacitation for all three types of assault.

For GNC students, we examined rates of each perpetration method for only the composite variable any sexual assault (due to small numbers in any specific type of assault). Among those who experienced an assault, incapacitation was the most frequently mentioned method (50.0%), followed by criticism (40.0%).

Aim 3: Identify factors associated with sexual assault experiences

We examined the association between sexual assault (both any sexual assault [ Table 4 ] and each type of sexual assault [ Table 5 ]) and key demographic, sexual history and social activity factors. Results are stratified by gender (women/men).

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Race/Ethnicity.

For both women and men, the prevalence of any sexual assault was similar for all race/ethnicity groups compared to non-Hispanic White students with one exception. Asian students (women and men) were less likely to experience any sexual assault than non-Hispanic White students. For women only, differences emerged by type of assault. Asian women compared to non-Hispanic White women were less likely to experience penetrative assault (OR = 0.35, CI: 0.19–0.62), but not attempted penetrative assault (OR = 0.56, CI: 0.25–1.26), nor sexualized touching only (OR = 1.00, CI: 0.59–1.69). Black women were found to have increased odds of touching only incidents compared to non-Hispanic White women (OR = 1.99, CI: 1.05–3.74). There were no other significant racial or ethnic differences.

Economic precarity.

Women who often or always had difficulty paying for basic necessities had increased odds of any sexual assault; for men the trend was similar but it did not reach statistical significance. Considering penetrative assault specifically, both men and women who often or always had difficulty paying for basic necessities had increased risk (women OR = 2.24, CI: 1.23–4.09; men OR = 3.07, CI: 1.04–9.07) compared to those who never had difficulty.

Transfer student.

Women transfer students were less likely to experience any sexual assault than non-transfer students. Closer inspection of type of assault revealed that this protective effect was seen for sexualized touching only (OR = 0.34, CI: 0.15–0.80), but not for penetrative (OR = 0.60, CI: 0.34–1.08), nor attempted penetrative (OR = 1.03, CI: 0.48–2.21) assault. There were no significant differences between men who were transfer students and those who were not.

For women, those who identified as bisexual and those who identified as some other sexual identity besides heterosexual, homosexual, or bisexual (includes people endorsing exclusively one or a combination of: Asexual, Pansexual, Queer, or a sexual orientation not listed), were more likely to experience any sexual assault than heterosexual students. For penetrative assault specifically, this increased risk was only present for individuals with some other sexual identity (OR = 2.11, CI: 1.20–3.73). For men, those who identified as homosexual were more likely to experience any sexual assault than heterosexual male students. For penetrative assault specifically, those who identified as homosexual, bisexual, or some other sexual identity all had substantially increased risk compared to those with a heterosexual identity (OR = 4.74, CI: 2.10–10.71; OR = 3.39, CI: 1.03–11.16; OR = 4.74, CI:1.10–20.48, respectively).

Information about the gender of the perpetrator for different gender and sexual orientation groups was available for a subset of incidents (336/997). Among these events, 98.4% (3/184) of the heterosexual women indicated the perpetrator was a man, while 97.1% (33/34) of the bisexual women, 75% (3/4) of the homosexual women, and 88.9% (24/27) of the other sexual identity women indicated it was a man. For men who were assaulted, 84.9% (45/53) of the heterosexual men reported the perpetrator was a woman, while 0 of the homosexual men said the perpetrator was a woman. Numbers for bisexual men and other sexual identity men were too small to report separately, but combined showed that 5/8 (63.0%) of bisexual and other sexual identity men said the perpetrator was a woman. Of the GNC students reporting on a most-significant event, 77.8% (7/9) reported that they were assaulted by a male perpetrator (the numbers are too small to further examine by sexual orientation).

Lived in US less than 5 years.

There was no association found between living in the US for less than 5 years and any sexual assault, nor any specific type of sexual assault.

Relationship status.

Among both women and men, students who had at least one hook-up were more likely to have experienced any sexual assault than students who were in only steady/exclusive relationships since starting college. Among women who had engaged in at least one hook-up, this increased risk held for each type of sexual assault (penetrative: OR = 5.03, CI = 2.91–8.68, attempted penetrative: OR = 4.43, CI = 1.83–10.8, sexualized touching only: OR = 3.26, CI = 1.74–6.09), while among men the increased risk was found for sexualized touching only (OR = 13.33, CI = 2.09–85.08), but could not be estimated (due to small numbers) for completed penetrative assault. Women who did not have any romantic or sexual relationship since CU/BC were found to be less likely to experience penetrative assault than women who had a steady/exclusive relationships only (OR = 0.05, CI: 0.01–0.31).

Fraternity/Sorority membership.

Although a relative minority of students participated in fraternities (24.1%) or sororities (18.2%), for both men and women, those who participated were more likely to experience any sexual assault than those who did not. Examination of type of assault revealed that the effect is driven primarily by sexualized touching only which is significant in both women (OR = 1.63, CI: 1.00–2.67) and men (OR = 2.40, CI: 1.25–4.63) and not significantly increased for penetrative nor attempted penetrative assault.

Risky or hazardous drinking.

For both men and women, individuals who met criteria on the AUDIT for risky or hazardous drinking were more likely to experience any sexual assault than those who did not. When examining each type of assault separately, for men this increased risk was only significant for penetrative assault (OR = 4.07, CI: 2.01–8.21). For women, the increased risk of assault held for each type of assault—penetrative (OR = 6.04, CI: 4.10–8.90), attempted (OR = 3.38, CI: 1.84–6.19) and touching (OR = 2.33, CI: 1.42–3.81). We also looked at one AUDIT item specifically on binge drinking (6 or more drinks on a single occasion). Individuals who reported binge drinking at least monthly were more likely to experience any sexual assault than those who did not. When examining each type of assault separately, for men this increased risk was only significant for penetrative assault (OR = 2.15, CI: 1.12–4.15). For women, this increased risk was significant for penetrative assault (OR = 3.12, CI: 2.09–4.65), attempted assault (OR = 2.28, CI: 1.20–4.33), and touching (OR = 2.42, CI:1.50–3.91).

Pre-college assault ( Table 5 ).

Among both women and men, those who experienced pre-college assault were more likely to experience any sexual assault while at CU/BC. The increased risk held for penetrative assault in both women (OR = 3.01, CI: 2.07–4.37) and men (OR = 2.44, CI: 1.03–5.76). In women, the increased risk also held for attempted penetrative, but not touching only, whereas in men, the increased risk held for touching only, but not attempted penetrative sex.

The SHIFT survey, with a population-representative sample, good response rate and behaviorally-specific questions, found that 22.0% of students reported a sexual assault since starting college, which confirms previous studies of 1 in 4 or 1 in 5 prevalence estimates with national samples and a range of types of schools [ 23 , 24 ]. However, a key finding is that focusing only on the “1 in 4/ 1 in 5” rate of any sexual assault obscures much of the nuance concerning types of sexual assault as well as the differential group risk, as prevalence rates were unevenly distributed across gender and several other social and demographic factors.

Similar to other studies [ 4 , 24 ], women had much higher rates of experiencing any type of sexual assault compared to men (28.0% vs 12.0%). Moreover, our data suggest a cumulative risk for sexual assault experiences over four years of college with over one in three women experiencing an assault by senior year. However, our data also suggest that freshman year, particularly for women, is when the greatest percentage experience an assault. This supports other work on freshman year as a particularly critical time for prevention efforts, otherwise known as the “red zone” effect for women [ 32 ].

Importantly, our study confirms that GNC students are at heightened risk for sexual assault [ 23 ]. They had the highest proportion of sexual assaults, with 38.0% reporting at least one incident, the majority of which involved unwanted/non-consensual sexualized touching. These data should be interpreted very cautiously given the small number of GNC students. However, increasingly studies suggest that transgender and other GNC students have sexual health needs that may not be targeted by traditional programming [ 57 ]; thus, a better understanding of pathways to vulnerability among these students is of high importance.

Similarly, students who identified as a sexual orientation other than heterosexual were at increased risk for experiencing any sexual assault, with bisexual women or women who identified as “other” and men who identified as any non-heterosexual category at increased risk. Similar to GNC students, understanding the specific social and sexual health needs of LGB students, particularly as it relates to reducing sexual assault risk is critical to prevention efforts [ 58 ]. Factors such as stigma and discrimination, lack of communication, substance use, as well as a potential lack of tailored prevention programs may play a role. To our knowledge, there are no evidence-based college sexual assault prevention programs targeting LGB and GNC students. Our data suggest that the LGB and GNC experiences are not uniform; more research should be done within each of these groups to understand the mechanisms behind their potentially unique risk factors.

Our data also suggest that the 20–25% rate of any sexual assault obscures variation in assault experiences. Sexualized touching accounted for the highest percentage of acts across gender groups, with over one-third of participants reporting only sexualized touching incidents. Rates of attempted and completed penetrative sexual assault were about half the rate of sexualized touching. This finding does not minimize the importance of addressing unacceptably high rates of attempted penetrative and penetrative assault (14%-15%), but it does suggest the importance of specificity in prevention efforts. For GNC students, for example, the risk of assault was primarily for sexualized touching with very few reporting attempted penetrative assault or penetrative assault during their time at CU/BC. These elevated rates of unwanted sexual touching may be a combination of GNC students’ focus on their gendered sexual boundaries–and thus potentially greater awareness of when advances are unwanted–at a developmental moment when they are building non-traditional gender identities, as well as these students’ social vulnerability. Further investigation is warranted.

Moreover, there was variation in methods of perpetration reported by survivors of sexual assault. Incapacitation was the most common method reported across all gender groups for each type of assault, and female and male students who reported risky or hazardous drinking were at increased risk for experiencing any sexual assault, particularly penetrative assault. Across campuses in the US, hazardous drinking is a national problem with substantive negative health outcomes, risk for sexual assault being one of them [ 2 , 39 , 59 ]. Our data underline the potential of programs and policies to reduce substance use and limit its harms as one element of comprehensive sexual assault prevention; we found few evidence-based interventions that address both binge drinking and sexual assault prevention. Of course, any work addressing substance use as a driver of vulnerability must do so in a way that does not replicate victim-blaming.

However, similar to other studies with broad foci, incapacitation was not the only method of perpetration reported. For women, physical force, particularly for penetrative sex, was the second most frequently endorsed method. Verbal coercion, including criticism, lying and threats to end the relationship or spread rumors, was also employed at rates similar to physical force for women, and was the second most frequently endorsed category for men and GNC students. Prevention programs, such as the bystander interventions which are the focus of efforts on many campuses [ 60 ], often focus on incapacitation or physical force. These interventions tend to highlight situations where survivors (typically women) are vulnerable because they are under the influence of substances. In SHIFT, verbal coercion is also shown to be a powerful driver of assault; however, it typically does not receive as much attention as rape, which is legally defined as penetration due to physical force or incapacitation. If a survivor is verbally coerced into providing affirmative consent, the incident could be considered within consent guidelines of “yes means yes” but it may have been unwanted by the survivor [ 61 , 62 ]. Assertiveness interventions and those that focus on verbal consent practices may be useful for addressing this form of assault.

We also found high rates of re-victimization. As others have found, pre-college sexual assault was a key predictor for experiencing assault at CU/BC [ 33 , 36 ]. However, we also found high rates of repeat victimization since starting at CU/BC with a median of 3 incidents per person reporting any sexual assault since starting CU/BC, and the highest risk of repeat victimization in women and GNC students. These data underline the importance of prevention efforts that include care for survivors to reduce the enhanced vulnerability that has been shown in other populations of assault survivors [ 36 ]. Future studies should also seek to disaggregate the relationship between type of victimization (sexualized touching, attempted penetrative assault, penetrative assault) and repeat victimization.

This study also identified a number of variables associated with sexual assault, some similar to previous studies and others different. As noted, gender was a key correlate. While prevention efforts should respond to the population-level burden by focusing on the needs of women and GNC students, it is important to note that men were also at risk of sexual assault. In our study, nearly 1 in 8 men reported a sexual assault experience, a rate also found in the Online College Social Life survey [ 56 ], but higher than other studies [ 63 , 64 ]. Few programs target men, and issues around masculinity and gender roles may make it difficult for men to consider or report what has happened to them as sexual assault. Importantly, this study found that men who were members of fraternities were at higher risk for experiencing assault (specifically unwanted/nonconsensual sexualized touching) than those who were not members. This is consistent with previous findings, including the Online College Social Life survey [ 56 ], but is of particular note because research has identified men in fraternities as more likely to be perpetrators [ 64 ], but few, if any, studies have looked at fraternity members’ vulnerability to sexual assault. Our data suggest a need for further examination of the cultural and organizational dimensions of Greek life that produce this heightened risk of being assaulted for both men and women. However, it is important to note that we did not examine a range of other social and extracurricular groups which may have produced risk as well and thus a more full examination of student undergraduate life is needed.

One other key factor associated with assault was participation in “hook ups”. Both male and female students who reported hooking up were more likely to report experiencing sexual assault, compared to students who only had exclusive or monogamous relationships and those who had no sexual relationships. The role of hooking up on college campuses has received much attention in the popular press and in a number of books [ 65 , 66 ], but little has been written about its connection to sexual assault, although several recent studies are in line with ours about its role as a risk factor for experiencing sexual assault on college campuses [ 40 , 41 ]. Multiple mechanisms may be at work: students who participate in hookups may be having sex with more people, and thus face greater risk of assault due to greater exposure to sex with a potential perpetrator, but students who participate in hookups may also face increased vulnerability because many hookups involve “drunk” sex, or because hookups by definition involve sexual interactions between people who are not in a long-term intimate relationship, and thus whose bodies and social cues maybe unfamiliar to each other. Alternatively some aspects of hook-ups may be more or less risky than others and therefore continued study of different dimensions of these more casual relationships that can refer to a wide-range of behaviors is necessary.

Several demographic characteristics were not for the most part associated with sexual assault. We did not find racial or ethnic differences in sexual assault risk with primarily one exception, Asian male and female students were at less risk overall compared to white students. We also did not find transfer students to be at greater risk; female transfer students were actually at lower risk, potentially due to less exposure time, particularly during freshman year. International student status as indicated by having been in the US<5 years was also not associated with increased risk. However, this study highlights the role of economic factors that have received limited attention in the literature. Little is known about how economic insecurity may drive vulnerability, but issues of power, privilege, and control of alcohol and space all require further examination.

There are several limitations to this study. Participants came from only two private schools that are interconnected in one city, and thus findings may not generalize to the rest of the US. There is a continued need for more national studies with different types of colleges and universities in urban and rural environments with more varied economic backgrounds in order to fully understand institutional and contextual differences. Although we had a response rate that was higher than many prior studies and our rates of sexual assault are consistent with prior studies [ 4 ], we cannot assess the extent to which selection bias may have occurred and therefore, our rates could be an underrepresentation or overrepresentation depending on who chose to participate. Although this concern is somewhat mitigated by findings that basic demographic data between respondents and the total population of students at two colleges suggest no significant differences, there may be some bias in factors we did not consider. Our present analysis has focused only on bivariate associations between risk factors and assault. While this analysis provides a valuable description of which groups are at elevated risk or not, future work will consider how combinations of risk factors at different levels may interact to increase risk. Critically, the analysis presented here reflects a focus on those who experience being assaulted, but in other work we look at the characteristics of perpetrators, both from those who reported perpetrating and from a subset of incidents that survey respondents described in depth, which provided more information about the perpetrator. A greater understanding of the characteristics and contexts of perpetration is without question vital for effective prevention. Finally, our data are cross sectional. Longitudinal studies with a comprehensive range of predictors are critical for identifying pathways of causality and targets for interventions.

Despite these limitations, this study confirms the unacceptably high rates of sexual assault and suggests diversity in experiences and methods of perpetration. A key conclusion is that a”one size fits all” approach that characterizes the extant literature on evidence-based prevention programs [ 67 ] may need to be altered to more effectively prevent sexual assault in college. Clearly different groups had differential risk for assault and may require much more targeted prevention efforts. Bystander interventions have shown promise in addressing risk in social situations, including fraternity parties and other settings with high alcohol use [ 68 , 69 ]. However, bystander interventions may not be sufficient for incidents occurring in non-party contexts where verbal coercion methods or physical force may be used without others around.

Creating effective and sustainable changes to campus culture requires engaging with a broad range of institutional stakeholders. SHIFT investigators are in the process of sharing selected findings with both student and institutional advisory boards, and an intensive collaborative process allows us to explore the implications of our results for a broad range of policies and programs, including both elements commonly considered as sexual assault prevention (consent education, bystander trainings), more general topics related to sexual orientation and verbal discussions of sex, and aspects of the institutional context across diverse domains including alcohol policy, mental health services, residential life policies, orientation planning, and the allocation of space across campus.

Overall, our findings argue for the potential of a systems-based [ 70 ] public health approach–one that recognizes the multiple interrelated factors that produce adverse outcomes, and perhaps particularly emphasizes gender and economic disparities and resulting power dynamics, widespread use of alcohol, attitudes about sexuality, and conversations about sex–to make inroads on an issue that stubbornly persists.

Supporting information

S1 table. number of incidents of sexual assault since enrolling at cu/bc, among individuals with at least one incident..

https://doi.org/10.1371/journal.pone.0186471.s001

Acknowledgments

The authors thank our research participants; the Undergraduate Advisory Board; Columbia University’s Office of the President and Office of University Life, and the entire SHIFT team who contributed to the development and implementation of this ambitious effort.

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Fact sheet: Intimate partner violence

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If you are in an emergency situation please access 9-1-1 (in Canada), for emergency services in your area.

If you are outside the 9-1-1 service area, please access available emergency services or call a  crisis line  in your area.

Intimate partner violence (IPV), also known as spousal or domestic violence, Footnote 1  is a prevalent form of gender-based violence (GBV). It refers to multiple forms of harm caused by a current or former intimate partner or spouse.

IPV can happen in many forms of relationships, including:

• within a marriage, common-law or dating relationship
• regardless of the gender and sexual orientation of the partners
• at any time during a relationship and even after it has ended
• whether or not partners live together or are sexually intimate with one another

The World Health Organization (WHO) identifies IPV as a major global public health concern, as it affects millions of people and can result in immediate and long-lasting health, social and economic consequences. Footnote 2  IPV impacts people of all genders, ages, socioeconomic, racial, educational, ethnic, religious and cultural backgrounds. However, women account for the vast majority of people who experience this form of gender-based violence and it is most often perpetrated by men. Footnote 3  There are serious impacts on children who are exposed to IPV, and exposure to IPV is considered a form of child maltreatment.

IPV can occur in both public and private spaces, as well as online, and can include:

• physical abuse : intentional or threatened use of physical force, including pushing, hitting, cutting, punching, slapping, shoving, strangulation
• criminal harassment (also referred to as stalking) : repeated conduct that creates fear for one’s safety or the safety of a loved one. The repeated conduct can include making threats, obscene phone calls, following, watching, tracking, contacting on the Internet, including through texts or email messages
• sexual violence : sexual acts without consent, threats of repercussions for refusing sexual activity, forcing someone to watch or participate in the making of pornography, sexually degrading language and belittling sexual comments Footnote 4
• emotional /psychological abuse : insults, belittling, constant humiliation, intimidation, threats of harm, threats to take away children, harm or threat of harm to pets Footnote 5
• financial abuse (also referred to as economic abuse): control or misuse of money, assets or property, control of a partner’s ability to access school or a job
• spiritual abuse : using a partner’s spiritual beliefs to manipulate, dominate or control them
• reproductive coercion : controlling reproductive choices, pregnancy outcomes and/or access to health services
• coercive control : patterns of control and abuse that cause fear or terror, including  coercion (using force and/or threats to alter behaviour) and control Footnote 6  (regulating or dominating a partner’s behaviour and choices, isolating a person from family and friends, and restricting access to employment, education or medical care) Footnote 5
• technology-facilitated violence (also referred to as cyberviolence ): use of technologies to facilitate virtual or in-person harm including observing and listening to a person, tracking their location, to scare, intimidate or humiliate a person

General application offences contained in the  Criminal Code  of Canada prohibit many forms of IPV, including:

• physical and sexual assault
• some forms of emotional/psychological abuse and neglect
• financial abuse Footnote 1

Six provinces (Alberta, Manitoba, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, and Saskatchewan) and three territories (Northwest Territories, Nunavut and Yukon) have enacted specific legislation on family violence. Footnote 7

In 1983, the  Criminal Code  was amended to replace outdated sexual offence laws with the current sexual assault offences. Among other things, these amendments ensured that a person could be charged with sexually assaulting their spouse. In 1993, the offence of criminal harassment (also referred to as stalking) was enacted. Most recently, in June 2019, the  Criminal Code  was amended to strengthen the criminal justice system’s response to IPV, including by defining ‘intimate partner’ for all  Criminal Code  purposes and clarifying that the term includes a current or former spouse, common-law partner and dating partner. The changes also reversed the onus of proof for bail for an accused charged with a violent offence involving an intimate partner, in cases where the accused had a prior conviction for violence against an intimate partner. This means that instead of the Crown having to prove why the accused should be held in custody while awaiting trial, the accused now has to prove to the court why they should be released.

By 1986, every Canadian jurisdiction had implemented mandatory charging and prosecutorial policies with respect to IPV. The mandatory charging policies require that police apply the same charging policy in all types of criminal offending, namely that charges be laid in IPV cases where there are reasonable grounds to believe an offence has been committed. Similarly, the mandatory prosecution policies generally direct that IPV cases should be prosecuted where there is a reasonable expectation or prospect of conviction (based on the evidence) and where it is in the public interest to prosecute. This approach ensures that the victim/survivor is not responsible for whether or not charges are laid or whether or not there will be a trial. Some jurisdictions have implemented specialized domestic violence courts. Footnote 8

Services that are available for victims/survivors of IPV include women’s shelters, transition houses, victim services, counselling programs and sexual assault centres.

The Government of Canada is working to increase its knowledge about this form of violence. Police-reported data show that women are overrepresented among those who experience IPV, including among victims of intimate partner homicides. As is the case with many forms of violence, those who experience IPV often do not to report it to the police for a variety of reasons, including: fear of stigma/shame, Footnote 9  the belief that abuse is a private matter, Footnote 10  fear of court system intervention, or lack of trust in the criminal justice system. Footnote 11

Here are some key facts:

Police-reported data Footnote 12  (2019):

• In Canada in 2019, of the 107,810 people aged 15 and over who experienced intimate partner violence (IPV) 79% were women Footnote 13
• As in previous years, 2019 rates of IPV were more than 3.5 times higher among women than among men (536 versus 149 per 100,000 population). Footnote 13

Self-reported data Footnote 14  (2018):

• Overall, 44% of women who had ever been in an intimate partner relationship—or about 6.2 million women aged 15 and over —reported experiencing some kind of psychological, physical, or sexual abuse in the context of an intimate relationship in their lifetime (since the age of 15). More specifically, women were significantly more likely than men to have experienced any form of IPV, including physical abuse (23% versus 17%, respectively), sexual abuse (12% versus 2%), and psychological abuse (43% versus 35%). Footnote 15
• Women, relative to men, were considerably more likely to have experienced the most severe forms of IPV in their lifetime (since the age of 15): being made to perform sex acts they did not want to perform (8% versus 1%), being confined or locked in a room or other space (3% versus 0.5%), being forced to have sex (10% versus 2%), being choked (7% versus 1%), and having harm or threats of harm directed towards their pets (4% versus 0.8%). Footnote 15
• Among people who experienced intimate partner violence in their lifetime (since the age of 15), women are about four time more likely than men (37% versus 9%, respectively) to have ever been afraid of a partner. 55% of women who experienced physical or sexual IPV feared a partner at some point. Being afraid of a partner can indicate intimate partner violence that is more coercive, more severe, and more likely to reflect a pattern of abusive behaviours. Footnote 15
• Women who have experienced physical or sexual abuse before the age of 15 were about twice as likely as women with no such history to have experienced IPV either since age 15 (67% versus 35%) or in the past 12 months (18% versus 10%). Footnote 15
• Among people who experienced IPV in the 12 months preceding the survey, women were twice as likely as men to have experienced at least one form of IPV on a daily or almost daily basis (12% versus 6%, respectively). Footnote 15
• Three in ten (29%) women 15 to 24 years of age reported having experienced at least one incident of IPV in the 12 months preceding the survey, more than double the proportion found among women between the ages of 25 to 34 or 35 to 44, and close to six times higher than that among women 65 years of age or older. Footnote 15

Young women (aged 15 to 24 years)

• Among young women who reported ever being in an intimate partner relationship, almost three in ten (29%) of those aged 15-24 years experienced some form of IPV in the 12 months preceding the survey. This proportion was much higher than that observed among women aged 25 years and older (10%). Footnote 16
• Young women were five times more likely than women aged 25 years and older to have been sexually assaulted (5% versus 1% respectively), three times more likely to have been physically assaulted (6% and 2%, respectively), and almost three times more likely to have been emotionally, financially or psychologically abused by an intimate partner in the previous 12 months preceding the survey (28% versus 10%). Footnote 16

Indigenous women

• Indigenous women (61%) in Canada were more likely to have ever experienced IPV in their lifetime (since the age of 15) when compared with non-Indigenous women (44%). Footnote 17
• In the 12 months preceding the survey, 1 in 6 (17%) Indigenous women experienced at least one form of IPV—psychological, physical or sexual—compared with 12% of non-Indigenous women. Footnote 17

Lesbian, gay, bisexual and people of a sexual orientation that is not heterosexual (LGB+) women

• Overall, 67% of LGB+ women who had ever been in an intimate partner relationship had experienced at least one type of IPV since the age of 15, compare to 44% among heterosexual women. Footnote 18
• Almost half (49%) of LGB+ women indicated that they had been physically or sexually assaulted by an intimate partner since the age of 15, almost double what was indicated by heterosexual women (25%) Footnote 18
• One in five (20%) LGB+ women had indicated that they had experienced some forms of IPV within the past year, almost twice what was said by heterosexual women (12%). Footnote 18

Women living with disabilities

• Among people who had ever been in an intimate partner relationship, more than half (55%) of women with disabilities reported experiencing some form of IPV in their lifetime (since the age of 15), compared to 37% of women without disabilities Footnote 19
• In the 12 months preceding the survey, 16% of women with disabilities experienced some form of IPV, compared to 10% of women without disabilities Footnote 19
• Among LGBTQ2 (Lesbian, Gay, Bisexual, Transgender, Queer and Two-Spirit) women with disabilities, almost seven in ten (71%) experienced some form of intimate partner violence since the age of 15. Footnote 19

Visible minority women

• Among those who had ever been in an intimate partner relationship, 29% of women belonging to an ethno-cultural group designated as a visible minority reported experiencing some kind of psychological, physical, or sexual violence committed by an intimate partner in their lifetime (since the age of 15) Footnote 20
• Visible minority women and non-visible minority women were equally likely to have experienced intimate partner violence in the form of physical abuse (both 2%) or sexual abuse (both 1%) in the past 12 months. Footnote 20
• One-quarter (25%) of visible minority women between the ages of 15 and 24 experienced IPV in the past 12 months. Footnote 20

Intimate partner homicide

• Between 2014 and 2019, there were 497 victims of intimate partner homicide, and—similar to intimate partner violence in general—80% (400 victims) were women. Footnote 13
• While Indigenous women account for about 5% of all women in Canada, they accounted for 21%  Footnote 21 of all women killed by an intimate partner between 2014 and 2019 (83 victims). In 2020, 53 women, 11 of whom were Indigenous, were killed by their partner in Canada. Footnote 22

You may access the following list of a dditional support services  for people affected by GBV.

• The Public Health Agency of Canada’s  Stop Family Violence  website is a one-stop source of information on family violence and has resources and information for anyone experiencing family violence.
• Justice Canada’s  Victim Services Directory  helps service providers, victims and individuals locate services for victims of crime across Canada.

This fact sheet was developed in collaboration with other federal government departments.

Publication date: fall 2020. Updated statistics in fall 2021.

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Landmark sexual violence survey reveals shocking data

Japan has a problem when it comes to preventing crimes and protecting victims.

More robust action against sexual violence and abuse is required in Japan, which lags behind many countries in terms of gender equality, ranking 125th in the World Economic Forum’s latest Global Gender Gap Index .

At the same time, underreporting remains a problem, as revealed by a landmark online survey conducted by NHK in 2022, whose questionnaire I helped draft.

In 2017, aspects of the Penal Code relating to sexual violence were amended for the first time in a century. The revision led to the prohibition of sexual and obscene acts involving those under 18, as well as the recognition of male victims for the first time.

Despite the changes, rape charges still required proof of violence or intimidation, or that the victim was "incapable of resistance." Subsequently, four rape cases sparked public outrage in 2019 by highlighting how this proviso made it difficult to convict offenders.

In one case, a father was acquitted of charges that he had repeatedly assaulted his then 12-year-old daughter. The judges ruled that, because this happened in the family’s small house, other family members would have been aware if there had been any resistance on the girl's part, but did not testify to this effect. (A higher court later overturned the acquittal and sentenced the man to seven years in prison.)

Following an outcry, the sex crime law was revised again last June . In addition, Japan hosted the Group of Seven summit last spring and was showered with unfavorable coverage regarding its stances on gender and LGBTQ rights, as well as domestic and sexual violence, which generated additional pressure for reform.

The crime of rape was changed to that of “nonconsensual intercourse,” therefore broadening the definition. Also, the law no longer requires there to be evidence of resistance and consent is no longer assumed to be intrinsic to marriage, as it was before.

Furthermore, the age of consent was raised from 13 to 16 , and the act of groping a person under 16 for the purposes of indecency or voyeuristic photography was criminalized. Moreover, the statute of limitations was increased by five years for the crimes of indecency (becoming 12 years), nonconsensual sex (15 years) and indecent assault (20 years).

The legal landscape has thus shifted due to heightened awareness of, and public anger over, crimes that had been off the radar for far too long. Helping stoke this outrage was the aforementioned NHK survey of victims of sexual violence and harassment, which drew 38,383 responses. To put this in context, such surveys typically elicit about 4,000 responses. Of the participants, 91.3% identified as female, 5.4% as “X-gender” and 1.1% as male.

Many victims reported multiple experiences of assault and abuse, including being undressed against their will (16.4%), penetrated by genitals or other body parts (18.6%), ejaculated on (8.9%), forced to watch as someone masturbated (10.8%), touched (39.6%) and verbally harassed with sexually explicit language (40%). Over half of victims claimed to suffer from post-traumatic stress disorder, however, only 3.3% were diagnosed, highlighting a shortage of specialists and care options.

I was especially shocked by the young age of many victims: Half were under 15 when they suffered abuse, while just over one-fifth were younger than 10. Overall, almost three-quarters of victims were below the age of 20.

The negative effects of these traumas are devastating. Many become emotionally unstable, suffer from insomnia, experience feelings of hopelessness and suffer from low self-esteem. In the survey, 36.7% blamed themselves for what had happened, 29.7% felt they had been defiled, 26% wanted to die and 11.8% said they had tried to commit suicide.

The survey also shows how unrealistic the resistance requirement for rape was prior to the most recent legal revision. Only about one-fifth of victims reported being able to physically resist their assaults. Many fell into a "frozen state" and were "unable to understand what was happening to them" (58.3%), "unable to think straight" (32.5%) and "unable to move" (38.8%).

Several victims also encountered an empathy deficit when sharing their experiences, with 23.5% being told that it was "no big deal" or "a common occurrence" and 14.9% being advised to forget about the incident and pretend it had never happened.

Such attitudes protect perpetrators, increasing the likelihood of repeat offenses and of victims feeling isolated. About one-third of survey respondents did not tell anybody about what happened (other than participating in the anonymous survey). Others felt vulnerable to retribution, with one person writing, “Because the perpetrator is a relative, I’m afraid of retaliation if I tell. I thought that talking about it wouldn’t solve anything. I don't know where to go for help.”

Many victims are suffering in silence and only a few reported reaching out to professionals of any sort: 2.3% consulted a one-stop support center for sexual violence or support group, 2.2% a medical institution, 0.9% a lawyer or other legal specialist and 10% the police.

The survey also found that perpetrators were found guilty in only one-tenth of cases in which victims went to the police. Inexplicably, police fail to record about half or more of the rape cases that are reported, according to research published earlier this year in the International Journal of Asian Studies. Therefore, official rape statistics are meaningless and, generally speaking, perpetrators enjoy a cocoon of impunity, with only between 10 to 20 convictions for every 1,000 cases, according to the aforementioned research.

The costs of such violence are not just psychological. Many victims are often unable to go to school or work, with long-term impacts on their development and earnings. In the survey, 7.5% of respondents said they had missed a significant number of school days and 2.2% quit education altogether. In addition, 24.3% of those affected in the workplace quit their jobs and 12.1% said they were no longer able to work full time.

These numbers are significant. Based on the data, we estimate that the 11,526 responses of those who quit their jobs or full-time work amounted to economic losses worth some 2,500 billion yen. One way of seeing this is that this is income the victims could have earned if they had not suffered abuse.

The government must lend more support to relevant services, including civil society organizations that play a key role in helping victims. There is also a dire need for nurturing expertise in diagnosing, treating and counseling victims, as well as facilitating access to such care.

As Japan moves toward better addressing the scourge of sexual violence, it is also essential to engage the police and judiciary in improving sensitivity toward victims and increasing accountability.

Sexual violence not only harms people, but the economy and society as a whole. And since the number of people whose well-being and work have suffered is far larger than what the survey reveals, the overall costs to society are also much, much greater.

Machiko Osawa is professor emeritus at Japan Women’s University in Tokyo. She is the author of “Building a Society Where Women Can Ask for Help: Sexual Violence and Gender Inequality in Japan” (in Japanese).

In a time of both misinformation and too much information, quality journalism is more crucial than ever. By subscribing, you can help us get the story right.

Survivors Sidelined

How illinois’ sexual assault survivor law allows hospitals to deny care.

Illinois hospitals routinely skirt one of the nation’s strongest laws protecting victims of sexual assault.

April 2, 2024 | by Kate Martin

In September 2021, a 4-year-old girl’s babysitter caught her touching another child inappropriately.

“I asked her why she was doing that,” the babysitter texted the girl’s mother, “and she told me because someone does it to her.”

Who does it? the babysitter asked the girl.

“Omfg,” the babysitter responded to the mother. “You're not going to be happy can you call me.”

She said her daddy does it, the babysitter told the mother.

The girl’s mother and grandmother brought the child to their local emergency room in Jacksonville, Illinois. (The girl and her family are not being identified because she is a victim of sexual assault.)

At Jacksonville Memorial Hospital, a doctor noted trauma to her vaginal area, records show. “My daddy touches me there,” she said during the exam, according to police records and an interview with the girl’s grandmother. 

A state law enacted 48 years ago required the hospital to offer a forensic exam, often called a rape kit. A revision passed in 2018 also required the hospital to notify a sexual assault advocate on the girl’s behalf.

But neither of those things happened, state inspectors found when they arrived two weeks later in response to a complaint. 

Instead, the doctor sent the girl home.

When faced with the inspectors’ findings, hospital leaders could have apologized and redoubled their efforts to treat sexual assault victims as the law intended.

Instead, they shut down services for sexual assault survivors. Today the hospital sends these patients 40 miles away to another hospital. A spokeswoman for Jacksonville Memorial Hospital declined to comment.

An investigation by APM Reports shows that what happened at the hospital in Jacksonville is not an isolated incident. Roughly two dozen hospitals have violated Illinois’ landmark sexual assault survivor law with few consequences.

Lawmakers also added a critical exception that undercut the premise of the law: Hospitals that found the requirements too onerous could send patients elsewhere. 

In the 17 years since lawmakers created that exception, the number of hospitals transferring patients instead of treating them has more than tripled.

Meanwhile, many hospitals that do treat sexual assault victims have failed to provide critical services. 

A review of publicly available inspection reports from 2018 through 2023 from the state Department of Public Health revealed 23 hospitals — from downtown Chicago to rural Centralia — violated state laws intended to protect sexual assault survivors. More than 200 patients were referenced in the reports. While some of these laws are relatively new, others have been on the books for decades.

State investigators have found:

Four hospitals failed or refused to offer sexual assault kits. 

Nine hospitals failed to contact a rape crisis center advocate.

Three hospitals delayed treatment. 

Nine hospitals failed to take photographs of injuries. 

Four hospitals failed to notify child or adult protective services. 

Eight hospitals failed to provide follow-up care instructions. 

Six hospitals billed victims for the cost of their exam, which has been illegal in the state for 48 years.

APM Reports found no evidence that any hospital has been fined since the law’s creation. While Illinois law allows the state to issue monetary penalties, it fails to specify who must do so in nearly all cases.

“I’m so revolted by this,” said state Rep. Jehan Gordon-Booth, a Democrat from Peoria who is the speaker pro tempore and chief budgeteer in the House. “These are individuals who have been victimized, oftentimes by a trusted person in their lives, and to then be re-victimized again — it’s just unconscionable.” 

Advocates say the number of unreported violations is likely much higher. State regulators only inspect hospitals every three years or in response to a serious complaint.

“We triage and prioritize the investigation of complaints based on the nature, scope and severity of the complaint allegations,” said Michael Claffey, spokesman for the Illinois Department of Public Health. “Those that require an urgent response are handled as quickly as possible.”

‘There should have been more done right then and there’

When hospitals fail to provide sexual assault victims immediate access to forensic exams, they may help sexual offenders escape punishment.

Experts say evidence collection should happen within seven days, but earlier is better. Each time the victim washes, urinates or moisturizes, the amount of DNA — which can implicate or exonerate suspects — diminishes.

But the distress caused by an assault can lead to delays. The 4-year-old girl’s mother said she was in shock and had been working double shifts several days in a row when she learned about her daughter’s assault. By the time the girl’s grandmother insisted on going to a hospital, it had been four days since the girl last saw her father.

Time was of the essence. But during the girl’s hospital visit, the grandmother wondered why there wasn’t a rape kit.

“I know what the rape kit all entails, and there wasn’t even a mention of that,” the grandmother said. “Honestly there should have been more done right then and there.”

The girl eventually received a forensic exam at a hospital an hour away in Springfield. By then, six days had passed since the girl had visited her father.

The father, who was never charged with a crime, declined to comment through his attorney. He told Illinois State Police investigators his daughter “has an overactive imagination,” records show.

Months later, the kit came back negative for any male DNA, according to a state crime lab report. That stood out to Cass County State’s Attorney Craig Miller, who declined to prosecute the case in 2022. He didn’t elaborate on other factors that he said went into his decision.

“I don’t have a crystal ball, but if she had not been denied care that day and they found DNA, I think that changes the whole outcome of the case,” Miller said after reviewing the case file. 

The state Department of Public Health investigated Jacksonville Memorial after it received a complaint about the girl’s care. Inspectors found four violations related to the incident: failing to contact a rape crisis advocate; failing to offer a medical forensic examination; failing to refer her to a provider with an expertise in pediatric sexual assault for follow-up care; and failing to obtain photographic evidence of her injuries.

There was no punishment. No agency fined the hospital for the violations, and the state medical board didn’t discipline the doctor. 

As for why the doctor did not offer her an exam, “I cannot spend two hours in a room with one patient,” he told state investigators. The doctor did not respond to email messages for this story. 

A year after the visit, the girl’s parents’ divorce was finalized. The girl’s father, who was never charged, shares custody of his daughter.

While some of the state’s investigative reports detailed relatively minor violations like failing to offer the survivor a shower, others outlined alarming decisions by medical professionals.

Inspectors found nurses at Advocate South Suburban Hospital in Hazel Crest threw away a woman’s clothes and the entire contents of her rape kit in 2021 after she left without signing one of many consent forms. Then, the hospital violated state law again — by sending her multiple bills related to her care, a complaint filed with the state attorney general’s office states.

“Instead of following up with the patient to get any part of the consent form signed, the hospital destroyed the kit,” an Illinois State Police forensic scientist wrote to the attorney general’s office.

“The case is still being investigated, with the survivor’s participation, and unfortunately the best potential evidence has been destroyed.”

The hospital’s forensic nurse coordinator at the time admitted to a state investigator that she told the nurse to throw the kit and clothing away. Through a spokesperson, the hospital declined to comment on this case, citing patient privacy. The hospital has since expanded the number of forensic nurses and increased training for clinicians to continue to treat sexual assault patients, the spokesperson said.

Julie Chor, a medical ethicist and associate professor of obstetrics and gynecology at the University of Chicago, said she was shocked by APM Reports’ investigation.

“It’s really our fundamental duty to take care of these individuals when they come to us seeking help. It just seems like this is such a systems failure,” Chor said. “It’s just so disheartening.”

‘An empty threat’

Illinois leads the nation in what it requires of hospitals after a sexual assault victim seeks help.

In most states, no law requires hospitals to have trained staff available for sexual assault exams. Even Virginia and West Virginia — which followed Illinois’ lead requiring forensic exams — do not protect patients to the same degree.

But the Illinois law is “an empty threat” — and hospitals know it, said Jaclyn Rodriguez, the former state sexual assault nurse examiner coordinator with the state attorney general’s office.

For 48 years, the law has stated that any hospital violating any provision “shall be guilty of a petty offense for each violation, and any fine imposed shall be paid” to the municipality where the hospital is located. But officials from several state entities and local governments — including the state Department of Public Health, the attorney general’s office, the state Legislature’s Joint Committee on Administrative Rules, the city of Chicago and the Cook County State’s Attorney’s Office — could not agree who is responsible for enforcing the law.

None were aware of any fines that had been collected due to hospitals’ violations of the sexual assault law.

Revisions to the law allowed the Illinois Department of Health to fine hospitals if they don’t respond to investigations or if they fail to submit plans to treat or transfer patients. A department spokesman said no fines were issued.

State lawmakers also gave the Illinois Attorney General’s office explicit enforcement authority over one small part of the law.

When medical providers bill sexual assault victims for care or send them to collections — a longstanding violation of Illinois law — that office can collect a fine of $500 per day.

Records obtained through a public records request show the attorney general’s office could have collected $1.4 million in fines in nearly eight years from hospitals, physician groups and testing laboratories that sent survivors to collections. But the office has not issued fines for these violations or any others, records show.

In response to this reporting, Annie Thompson, a press secretary for the attorney general’s office, said the law doesn’t require the office to issue fines. Attorney General Kwame Raoul “believes working with hospitals” yields better outcomes, she said.

“To date, we have received no evidence to indicate hospitals intentionally or maliciously refer survivors to collections,” the statement said.

Through mid-2023, people contacted the attorney general’s office asking for help with 28 bills related to sexual assault care that were sent to collections — which is against the law. Of those, 14 were in collections for longer than 100 days and one was in collections for 399 days, records from the office indicate.

‘The man who raped me is going to get away with it’

Hospitals need not violate Illinois’ landmark law to avoid providing care for sexual assault victims.

In 1976, when Illinois lawmakers first passed the groundbreaking law guaranteeing care for victims of sexual assault , they required all hospitals to meet the same strict standards. That changed with a fateful revision in 2007.

The update included a provision which allowed hospitals to decide whether to treat or transfer patients. Before the bill passed unanimously in both houses, lawmakers noted it was the product of collaboration among advocates, state officials, and lobbyists for the hospital industry, legislative transcripts show.

Since then, most of the state’s hospitals, including Jacksonville, can choose to transfer sexual assault patients instead of treating them — so long as they get the state health department’s approval. 

As more hospitals choose to transfer patients, some victims are forgoing care altogether.

Cheryl Thompson, 62, was celebrating the new year at a bar with someone she considered a friend, when she suddenly blacked out after a drink at the bar. She awoke hours later in near-freezing weather, on her back in her driveway. Later, she found pebbles, dried leaves and dirt inside her pants.

At Union County Hospital in Anna, Thompson told a doctor she thought she had been raped. 

But the doctor told her “no one would have been able to force” a woman her size to have sex unwillingly, and that “no one would have put drugs in her drink in Union County,” according to Thompson’s statement to police. He repeatedly asked her what she wanted him to do, Thompson said in a complaint to the medical board.

“I would answer him, ‘I want you to look at me or test me or whatever.’ And he told me, ‘We don’t do rape kits here — no one in our area does them. You have to go to Mount Vernon,’” she said in an interview.

Mount Vernon is an 80-minute drive from the hospital in Anna — the longest transfer in the entire state.

When a hospital opts not to treat victims, it must direct the patient to a hospital with which it has an agreement. Some one-way trips are longer than an hour. Several hospitals around the state, including the one in Anna, send patients dozens of miles farther than the closest hospital that will treat a sexual assault victim.

Fearful doctors in Mount Vernon would treat her with similar skepticism, Thompson decided not to go.

Although Union County Hospital’s transfer agreement is with a hospital in Mount Vernon, the nearest treatment hospital was actually 25 minutes away in Carbondale, a distance Thompson said she would have been willing to drive.

By the time Thompson learned about the hospital in Carbondale, nine days had passed since the assault.

A forensic nurse there found bruising on her inner thighs and bloody scrapes on her knee and elbow. She also helped her file a police report. 

“The man who raped me is going to get away with it because I couldn’t get my rape kit done in enough time to get the proof that I needed,” she said through angry tears in an interview with APM Reports.

A spokeswoman for Deaconess Health, which owns Union County Hospital, defended its actions, saying not all treatment hospitals in southern Illinois accept transfers from other hospitals.

“Some are limiting [Sexual Assault Nurse Examiner] care to only those patients who first come to their facility,” the spokeswoman wrote, noting that Union County Hospital signed its transfer agreement with the hospital in Mount Vernon before the surrounding hospitals offered those services.

State law prohibits the Department of Public Health from approving a hospital’s transfer plan if it would “unduly burden the sexual assault survivor.”

But when asked why the department approved the transfer plan that sends rape victims more than 70 miles away even though other treatment hospitals are closer, Claffey, with the state Department of Public Health, said, “We are not in a position to comment on decisions that hospitals make.”

Later, he added that the department does have the authority to deny a transfer plan that places an undue burden on survivors, but said lawmakers would need to define “undue burden” more specifically for the department to deny transfer plans based on distance.

State Rep. Kelly Cassidy said long transfer distances are a statewide problem.

“It doesn’t look like hospitals are being held accountable,” Cassidy, a Democrat, said. “We need to have a very intentional approach to making sure we fix this.”

Rodriguez, the former state sexual assault nurse examiner coordinator, said some in her field prefer an alternative to transferring patients.

“Your option should be for a practitioner to go to you,” she said. “The burden shouldn’t be on the survivor like it is now. It should be on the hospital and healthcare provider who didn’t just go through trauma.”

‘They’re going to have to answer for this’

In 2018, lawmakers set out to strengthen the Illinois sexual assault survivor law once again. 

The bill required hospitals to train emergency room workers in trauma-informed care and ensure every sexual assault victim has access to a rape crisis advocate. It also required treatment hospitals to provide forensic services within 90 minutes of a victim’s arrival.

That year, none of the state’s nearly 200 hospitals had forensic nurses available around the clock, according to the state attorney general’s office.

“Illinois wasn’t in the place we wanted it to be in terms of responding to sexual assault survivors,” said Carrie Ward, CEO of Illinois Coalition Against Sexual Assault, a state nonprofit supporting more than 30 regional rape crisis centers.

In some ways, lawmakers’ efforts were successful. Since the law passed, the number of nurses certified as sexual assault examiners has skyrocketed, from about 200 in 2019 to nearly 500. The number of forensic nurses specializing in pediatric cases also more than doubled, from 33 in 2019 to 68 in 2023, records say.

But in other ways the revisions are failing victims of sexual assault. 

If hospitals couldn’t or didn’t want to comply with the new requirements, they had an out. The 2007 exception to the law meant hospitals that didn’t want to meet the new requirements could simply transfer patients to another hospital.

In an emailed statement, Paris Ervin, a spokeswoman for the Illinois Health and Hospital Association, said the 2018 law was to blame for the increase in transfer hospitals.

A nationwide nursing shortage and limited access to required training made the revision a foreseeable failure, she said, particularly for smaller and more rural hospitals.

“Hospitals have been forced to transfer survivors from their communities to treatment hospitals in different communities, in order to maintain compliance with the law,” Ervin said.

A proposed rule change might hold transfer hospitals to a higher standard.

Six years ago, lawmakers tasked a group of nurses, hospital representatives and victim advocates with recommending changes to how hospitals treat patients after a sexual assault. That group has proposed new rules requiring transfer hospitals to contact a rape crisis advocate, treat patients for sexually transmitted infections, screen for drug-facilitated rape and train certain emergency room staff.

The rules have yet to be approved.

At the Statehouse, lawmakers say they’re paying attention to shortcomings in the law.

“To hear that rape victims are being turned away,” Rep. Gordon-Booth said, will be of importance “to every member of the Illinois General Assembly.”

As speaker pro tempore, Gordon-Booth is in charge of the budget at the Statehouse. She noted the state “funds hospitals significantly” with billions in taxpayer money flowing to Illinois hospitals every year. 

“Here’s the reality: They're going to have to answer for this,” Gordon-Booth said. “There's no way that these entities are going to be able to come back to the Legislature — as they do every year — and not be accountable.”

Program helping sexual assault survivors in rural Manitoba under threat as feds nix funding

Sarah program only one of its kind in interlake-eastern region, says crisis centre.

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An organization that helps sexual assault survivors in rural Manitoba embark on the journey toward recovery says the future of its main program is in question now that the federal government is discontinuing funding for it.

Survivor's Hope Crisis Centre has been running its Sexual Assault Recovery and Healing program, also known as SARAH, for about five years.

The program offers victims of sexual assault, abuse, harassment, exploitation and trafficking in the Interlake-Eastern region free long-term counselling, as well as access to advocacy, legal supports and opportunities to build communities with other survivors through healing groups.

Coral Kendel, the executive director of Survivor's Hope, says SARAH is the only program of its kind in the region, with the exception of one program in Brandon. She said it holds thousands of counselling sessions every year, helping hundreds of survivors heal.

But that may not be the case soon.

Survivor's Hope has been receiving support from the federal government to keep SARAH running for the past three years. In an email sent to the crisis centre last week, which was shared with CBC News, an official with the federal Justice Department said the funding would be discontinued.

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"Our initial reactions were obviously devastation, and what that meant for the survivors that we work with and the severe outcomes that that cut can cause," Kendel said.  

"The largest portion of where our funding goes is to employing those caring individuals who can have those trusting relationships with survivors. And so without that funding … it will mean a reduction of our staff team and because of that, that's less support available."

Kendel said the cuts could mean the centre may not be able to follow up with youth who may need counselling whenever they hold workshops in schools.

She also added that, because there aren't other local supports, it could mean survivors may not have help navigating "confusing systems" like police and the courts, potentially leading to dire outcomes like trauma, substance abuse, or even suicide.

Cuts 'devastating,' survivor says

Robyn Laurie Sugden first came to Survivor's Hope as an employee, but it wasn't until she stopped working there that she realized how much she could use the help.

"A lot of the times, when people do experience sexualized violence, [they] may not realize that the experiences that they had weren't consensual until … a little bit later — and that was the situation with me," she said.

Sugden, who experienced sexual violence in her youth, said it wasn't until she started receiving free counselling under the SARAH program that she was able to deal with the trauma that she'd bottled up for years.

It really could be life or death for some people. - Robyn Laurie Sugden

She said she doesn't want to think about what will happen now that the program is in danger.

"This week has been very hard for survivors.… I've had a lot of people that have reached out to me, who are devastated," Sugden said.

"It really could be life or death for some people, because when you go through something like this, it affects everybody very, very differently."

The Justice Department said in its email to Survivor's Hope funding for the sexual assault component of the Victims Fund was limited, and the government was unable to approve all applicants.

A department spokesperson told CBC News in an email Thursday that, over the last three years, the federal government gave Survivor's Hope a total of $168,849 to develop a wrap-around support program for survivors and victims, but the funding was only for a set period ending March 31 — not on an ongoing basis.

The spokesperson added the organization also received a $10,000 and $9,000 grants in 2022 and 2023 for National Victims and Survivors of Crime Week activities.

Survivor's Hope is now trying to crowdfund the $75,000 it said it would need to run the program for another year, though Kendel said she's looking for more reliable funding from government. The province does not directly provide money for SARAH, she added.

'It's important to recognize the statistics'

Manitoba has the highest rate of police-reported sexual assault cases in rural areas, with 170 incidents per 100,000 people in 2021, according to Statistics Canada.

Kendel said Survivor's Hope survey from last year found 40 per cent of respondents in rural Manitoba said they or someone they knew had experienced sexual violence in their community.

"As much as we want to pretend that our society is safe or that we live in a place where this doesn't happen — specifically in small towns in Manitoba — I think it's important to recognize the statistics," Kendel said.

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"It's not [just] the one in four that gets reported. It's so much more prevalent than that, because people don't have safe spaces to come forward and disclose and share their experiences — and we are the ones who they're able to do that with."

Kendel said they're also seeking for more reliable funding from government.

She said the cut doesn't just affect Survivor's Hope, but that it will continue having ripple effects elsewhere.

"It puts further strain on the health-care system, on the justice system," Kendel said. 

"It is a deficit to our other social services out here who we often partner with, like harm reduction and mental health organizations — and also the organizations in Winnipeg who would then have to pick up the slack."

ABOUT THE AUTHOR

Arturo Chang is a reporter with CBC Manitoba. Before that, he worked for CBC P.E.I. and BNN Bloomberg. You can reach him at [email protected].

Sexual Assault Awareness Month

This Sexual Assault Awareness Month, Rise Above Violence is working to ensure our community knows we provide crisis response and support for sexual assault survivors.

Though we hope no one in our community ever again experiences the trauma of sexual assault, we stand ready to help you and your loved ones in case of the unthinkable.  Too often, sexual assault remains hidden due to manipulation, fear, shame and embarrassment.

However, the statistics are staggering:

• An American is sexually as- saulted every 68 seconds.
• Every nine minutes, that victim is a child.
• Of those children, 93 percent are assaulted by someone they know.
• More than 52 percent of women and more than 29 percent of men experience sexual violence in their lifetime.

This crime occurs within every socioeconomic level, faith background and community. It can be hard to believe, but sexual assault happens here in a paradise like Pagosa. That is why our theme for Sexual Assault Awareness Month this year is “Building Connected Communities.” It is our hope that Pagosa Springs comes together in strong, unwavering support of survivors.

The staff at Rise Above Violence hope you will join us this month — and every month — in acknowledging the issue of sexual as- sault and educating ourselves so we can prevent this terrible crime and respond well in the instances when prevention has not occurred.

Please join our Push-Up Challenge, and participate in our Denim Day Walk at noon on April 24 at Bell Tower Park.

If you are a survivor in need of support, please know you can reach out to us at any time through our 24-hour hotline: (970) 264-9075. All calls are free and confidential, and it is our honor to walk next to you as you seek support and healing.

The Pagosa Daily Post welcomes submissions, photos, letters and videos from people who love Pagosa Springs, Colorado. Call 970-903-2673 or email [email protected]

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Duncan Mayor proclaims April as Sexual Assault Awareness Month and Child Abuse Prevention Month

Apr. 12—Proclamations highlighted the Duncan council meeting Tuesday night as Mayor Robert Armstrong designated April 2024 as Sexual Assault Awareness Month and Child Abuse Prevention Month in Duncan.

Ahead of regular city business, Mayor Armstrong read a few statistics about who is affected by sexual assault.

"Sexual assault affects people of every age, race, sex gender identity, sexual orientation, religion, national origin, and socioeconomic background," he said. "The CDC reports in its National Intimate Partner and Sexual Violence Survey that in the United States, one in five women and one and 71 men have been sexually assaulted in their lifetime."

He said the awareness month will call attention to many misconceptions and misinformation about the crime.

"It is important that we rededicate ourselves to creating a society where sexual assault is not tolerated, survivors are supported and all persons in our community can live without fear of sexual assault," he said.

Armstrong said education can help reduce the crime and help survivors heal.

"We are grateful to the various agencies in the City of Duncan which carry out the difficult and necessary work to help victims out of domestic violence situations," he said.

Next, Armstrong read the proclamation to declare April 2024 as Child Abuse Prevention Month.

In Duncan, Armstrong said they strive to provide a nurturing and healthy development of children in the community.

"Research shows that safe, nurturing relationships and stimulating, stable environments improve brain development and child wellbeing, while neglectful or abusive experiences and unstable or stressful environments increase the odds of poor childhood outcomes," he said. "The abuse and neglect of children can cause severe and lifelong problems affecting all of society, including physical and mental health problems, school failure and criminal behavior."

Armstrong said children need to be made a top priority and urged the community to "take action to support the physical, social, emotional and educational development and competency of all children."

For April, Armstrong said the Safe Center will collaborate with citywide partners to engage with people throughout Duncan to prevent and bring awareness to child abuse and neglect.

Armstrong encouraged Duncan residents to recognize how prevention can start with them.

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ENC woman speaks out follow sexual assault encounter

GREENVILLE, N.C. (WITN) - The month of April is National Sexual Assault Assault Awareness and Prevention Month.

According to statistics, 133,294 people were sexually assaulted in 2022.

Now one county in the East is taking action by raising awareness and reminding people of the services offered through one county program.

Greenville’s Patrice Wallace knows the issue first-hand. “I was at Walmart on Wednesday, just shopping as usual in the aisle, and all of a sudden, I looked up and there was a guy in my face, and he walked by and he grabbed my butt,” said Wallace.

Wallace says it was a nightmare that she never expected. “It was early in the morning, so I thought I was going, and no one was going to be there. Very unexpected and a lot of fear and disbelief. When he did touch me and grab me, it was kind of like... what just happened? A lot of fear. Honestly, it was very unexpected. He’s walking really fast towards me so then I run. I run and I find two employees in the store.”

Following the frightening encounter, Wallace says a police report with Greenville Police was filed.

According to GPD, an investigation into the alleged assault is underway.

According to the North Carolina Coalition Against Sexual Assault, 1 in 5 women will experience sexual assault in North Carolina.

With April being Sexual Assault Awareness and Prevention Month, Carteret County is doing its part to spread the word.

Vicki Wank, Carteret County Rape Crisis Program Director says, “We provide victim advocacy for anyone who is a victim of sexual assault past or present. We do education and presentations to the community to raise awareness about our program and ways to prevent sexual assault and help support survivors. We go to the hospital with survivors when needed, we help them through the court process.”

It’s such services that Wallace says are vital to recovery. Wallace told WITN, “Trauma, things that happen... if we don’t deal with them, it becomes a bigger problem so I would definitely encourage someone to seek out counseling and programs just to take care of the issue.”

For any survivors of sexual assault, there are also virtual resources like the National Sexual Violence Resource Center , as well as the National Sexual Assault Hotline that provides 24/7 confidential support.

The National Sexual Assault Hotline number is 1-800-656-4673.

For more information on the Carteret County Rape Crisis Program, you can visit their website .

NYPD ANNOUNCES CITYWIDE CRIME STATISTICS FOR MARCH, FIRST QUARTER 2024

April 3, 2024

Substantial reductions attained in subway system while shootings, major crime categories continue downward trends

New York City saw continued reductions in overall crime through the first quarter of 2024, both above ground, on streets throughout the five boroughs, and below ground, within the nation’s largest subway system. The single month of March 2024, compared to the same month last year, experienced even more drastic crime declines.

Overall crime in the transit system plummeted 23.5 percent in March, an achievement directly attributable to the 1,000 additional uniformed NYPD officers surged into the network each day. Another 800 NYPD officers were also recently deployed as part of “Operation Fare Play,” an initiative focused on enforcing fare evasion. The year-over-year crime decrease was led by double-digit percentage drops in major categories: Robbery was reduced 51.9 percent (26 vs. 54), grand larceny decreased 15.2 percent (89 vs. 105), and felony assault dropped 10.9 percent (49 vs. 55). From January 1 through March 31, 2024, overall crime in the transit system was down 1.1 percent (538 vs. 544), compared to the first quarter of 2023.

Since the start of 2024, overall arrests in the subway system are up almost 53 percent compared to last year (4,813 vs. 3,147), including an 83.3 percent increase in gun arrests (22 vs. 12), a nearly 80 percent jump in fare-evasion arrests (1,864 vs. 1,038), and a 24.1 percent hike in grand larceny arrests (108 vs. 87). In that time frame, Criminal Court summonses issued by police jumped 65.3 percent (1,666 vs. 1,008), and included an increase of nearly 5.5% (370 vs. 351) in those written specifically for fare evasion. The total number of Transit Adjudication Bureau (TAB) summonses issued for various offenses also climbed 28.1% (48,771 vs. 38,082).

“There cannot be a sense of lawlessness in the subway system, and it begins at the turnstiles,” said Police Commissioner Edward A. Caban . “It is highly encouraging to see the tangible results of our hard work – the investment we are making is clearly paying dividends. We vow to maintain our tight focus on the drivers of crime in order to improve transportation safety – and perceptions of safety – at every station, on every train, at all hours of the day and night. That is what New Yorkers expect and deserve.”

Citywide in March 2024 compared to March 2023, overall crime dropped 5 percent, a reduction of 505 incidents. Continued declines were recorded across many bellwether crimes, including murder, down 19.4 percent (29 vs. 36); burglary, down 17.4 percent (1,005 vs. 1,217); and grand larceny, down 7 percent (3,883 vs. 4,176). Robbery was flat in March (1,264 vs. 1,264), while grand larceny auto – the theft of motor vehicles – declined for the fourth month in a row, down 10.9 percent (1,037 vs. 1,164). From January 1 through the end of the first quarter of 2024, major crime and violence throughout the five boroughs dropped 2.4 percent, a decrease of 711 incidents.

Shooting incidents in March 2024 were reduced 25.9 percent (63 vs. 85), equating to 29 fewer shooting victims compared to the same month last year (71 vs. 100), a 29 percent decrease. This correlates to 358 people arrested for possession of an illegal firearm, a 7.5 percent increase from the same period last year. Shooting incidents for the first quarter of 2024 compared to 2023 were down 18.5 percent (181 vs. 222), meaning that 56 fewer people (212 vs. 268) were shot in New York City since the start of the year, a 20.9 percent reduction. From January 1 through the end of March, the NYPD took nearly 1,600 illegal guns off New York City streets, adding to the 15,180 total guns seized since the start of 2022.

In March 2024, compared to the previous March, the total number of bias incidents investigated by the NYPD’s Hate Crime Task Force across the five boroughs increased by 27 incidents. Overall crime in New York City public housing developments dropped 6.2 percent.

For all major index crimes in March, 479 additional people were arrested compared to a year ago, an 11 percent increase (4,826 vs. 4,347). Since the start of the year, 1,398 more people were arrested for major crimes this year, marking an 11.1 percent jump (13,980 vs. 12,582).

*All crime statistics are preliminary and subject to further analysis, revision, or change.*

Index Crime Statistics: March 2024

Index Crime Statistics: Q1 (Jan. 1 – March 31)

Additional Statistics: March 2024

Additional statistics: q1 (jan. 1 – march 31)    , rape incident reporting statistics: march   2024.

(Reports filed from March 1 – March 31 in years indicated)

Rape continues to be underreported. If you are a victim of sexual assault, please come forward. The 24-hour NYPD Special Victims Division hotline is: 212-267-RAPE (7273).

Hate Crimes Statistics: March 2024

(Representing March 1 – March 31 for calendar years 2024 and 2023)

Note: Statistics above are subject to change upon investigation, as active possible bias cases may be reclassified to non-bias cases and removed from counted data.

Residents Outside Moscow Protest Power Outage, Demand Heating Amid Subzero Temperatures

Residents of a Moscow region town impacted by power outages have taken to the streets, demanding that local authorities restore heat to their homes as subzero temperatures grip the region, Russian media reported Friday.

At least 21,000 people had power knocked out in their homes on Thursday morning in the town of Podolsk when a heating main burst at the Klimovsk Specialized Ammunition Plant, according to the Kommersant business daily.

The circumstances surrounding the incident at the plant in Podolsk, located some 50 kilometers south of Moscow, have not been disclosed.

The Telegram news channel Ostorozhno Moskva published a video of several local residents who gathered in the town's central square to demand the authorities restore their heating, as well as punish those responsible for the outage.

“The police arrived quickly to disrupt us. I wish they’d brought back heating as fast as they dispatched the cops,” the person recording the video could be heard saying.

A Change.org petition with identical demands was launched online, which, by Friday evening, was   signed by nearly 2,000 people.

“Since more than 24 hours have passed, we ask to punish all those involved in this emergency,” the petition reads, naming Podolsk Mayor Grigory Artamonov and the heads of local utilities as the culprits.

Households in the Moscow region towns of Khimki, Balashikha, Solnechnogorsk, Lyubertsy and Elektrostal also experienced heating loss  as a result of power outages, with temperatures in the area plummeting to minus 20 degrees Celsius, according to the investigative news website iStories. 

The Podyom news outlet, without citing its sources, reported that prosecutors have launched an investigation into the outages.

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We, the journalists of The Moscow Times, refuse to be silenced. Our commitment to providing accurate and unbiased reporting on Russia remains unshaken. But we need your help to continue our critical mission.

Your support, no matter how small, makes a world of difference. If you can, please support us monthly starting from just 2. It's quick to set up, and you can be confident that you're making a significant impact every month by supporting open, independent journalism. Thank you.

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Sexual Violence and Trauma in Childhood: A Case Report Based on Strategic Counseling

Valeria saladino.

1 Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio, 03043 Cassino, Italy

Stefano Eleuteri

2 Faculty of Medicine and Psychology, Sapienza University of Rome, 00178 Rome, Italy; [email protected]

Elisa Zamparelli

3 Institute for the Study of Psychotherapies, 00185 Rome, Italy; [email protected]

Monica Petrilli

4 Academy of Social and Legal Psychology, 00198 Rome, Italy; ti.liamtoh@illirtepacinom

Valeria Verrastro

5 Department of Medical and Surgical Sciences, University of “Magna Graecia”, 88100 Catanzaro, Italy; ti.zcinu@ortsarrevairelav

Children and adolescents are too often victims of sexual abuse and harassment. According to the World Health Organization (WHO), approximately 150 million girls and 73 million children <18 have been victims of violence and sexual exploitation during their childhood. Data show that females are more likely to be a victim of abuse and violence than males (20% vs. 5–10%). Such abuses lead to long-term psychophysical and relational consequences and victims are often afraid of asking for support from both parents and professionals. This case report shows the story of a 17-year-old adolescent, Sara, involved by her mother in a strategic counseling process, to solve BDSM-type sexual addiction (slavery and discipline, domination and submission, sadism and masochism), self-aggressive behavior, and alcohol abuse issues. The strategic counseling process is structured in 15 sessions and was based on problem-solving techniques and corrective behavioral strategies. During the sessions, it emerged that Sara had been a victim of sexual violence at the age of 6 and that she had never talked about the rape with anyone. At the age of 12, she began to experience social anxiety and shame, feelings that led her to use alcohol and seek violent sexual partners and bondage relationships. During the counseling sessions, Sara elaborated on her trauma, becoming more aware of her resources and her desires, and she learned to manage the sense of guilt and shame associated with the violence suffered, through alternative strategies. At the end of the process, Sara normalized her relationship with sex and alcohol, regaining her identity.

1. Introduction

1.1. sexual abuse in childhood: definitions, spread, and consequences of the phenomenon.

The World Health Organization defines “child maltreatment” as all the forms of abuse and neglect that involve children. This definition includes physical and emotional violence, sexual abuse, neglect, and exploitation. These abuses lead to damage to children’s health, impacting their development [ 1 ]. According to the fundamental rights of the European Union and the United Nations Convention on the Rights of the Child, children should be protected against all forms of violence, and adults should promote their well-being [ 2 , 3 ]. There are different definitions of child sexual abuse. For instance, sexual harassment can arise on a continuum of power and control, from non-contact sexual assault (such as exhibitionistic actions) to contact sexual assault (such as rape). Additionally, Internet sexual offending is included in the definitions of child sexual abuse. This category concerns the distribution, acquisition, and possession of child sexual exploitation material, child grooming, and online contact with children for gratifying sexual desire (e.g., receiving sexually explicit images or cybersex) [ 4 ]. Regarding the spread of this phenomenon, it is estimated that one billion children are a victim of some form of violence. Thus, one out of two children per year worldwide suffers from some form of violence. Furthermore, the COVID-19 pandemic has increased the risk of children being victims of violence within their families [ 5 , 6 ]. Indeed, social distancing and restrictions impacted the levels of stress and anxiety, reducing usual sources of support and increasing online abuse [ 7 , 8 ].

Our study focuses on sexual violence and sexual abuse, which means the involvement of children or teens in sexual coercion or sexual harassment. These experiences may not involve explicit violence or injury and could occur without physical contact or be experienced as observers. Sexual abuse can be divided into different categories depending on the relationship between the child and the perpetrator. Intra-familial abuse is implemented by family members, peri-familial abuse is implemented by people external to the family but who take care of the child; and extra-familial abuse involves perpetrators who are not part of the family environment [ 9 ].

Child sexual abuse is connected to several unpleasant consequences. Victims may develop mental health problems, such as affective disorders, suicidal ideas, drug or alcohol addiction, social anxiety, conduct disorder, borderline personality disorder, post-traumatic stress disorder, and eating disorders, in particular bulimia nervosa [ 4 ]. Furthermore, child sexual abuse harms the physical health of children, leading to urogenital complaints (e.g., genital pain, dysuria, genital bleeding, and incontinence problems) [ 10 ]. According to Adams et al. [ 11 ], the severity, duration, and onset of sexual abuse influence the level of depressive, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Regarding gender differences, the authors found that sexual abuse produces the worst effects in females. Indeed, the early onset of sexual abuse may cause anxiety symptoms in females but not among males. In the same line, it seems that sexual abuse may determine PTSD mostly in females but not in male adolescents.

The stage of development in which children suffered from abuse (early childhood, childhood, adolescence) can influence the severity of the consequences for health. Traumatic experiences, such as violence and abuse, lived during the first few years of life have a stronger impact on the development than those experienced in another period [ 12 ]. Van Duin et al. [ 13 ] examined the impact of extra-familial sexual abuse among children under four years old and the consequences for their parents. The results show that 3% of children developed a PTSD diagnosis, 30% of them exhibited clinically significant sexual behavioral problems, while 24% of them showed internalizing problems, 27% attachment insecurity and 18% received a psychiatric disorder diagnosis. Regarding parents of children who suffered from abuse, 20% reported high levels of PTSD symptoms, with mothers reporting PTSD symptoms more often than fathers. They also suffered from feelings of guilt, shame, and anger. The authors hypothesized that the psychological treatment provided to 25% of the victims and 45% of parents mitigated the negative consequences.

Additionally, suffering from extreme abuse for a long period, having a close relationship with the perpetrator [ 14 ], and living in dysfunctional families are risk factors associated with the development of severe psychological symptoms [ 15 ]. Moreover, the risk of re-victimization is higher among children who suffered from sexual abuse compared to others. The disclosure of the trauma is hard because of feelings of shame, guilt, and intimidation by the perpetrators and the wish to not burden the family. The stigmatizing response by the social environment influences the development of shame and guilt linked to sexual victimization. This is also connected to the feeling of being blamed or judged.

These data underline the importance of educating society in understanding the consequences of sexual victimization and in supporting prompt reporting. These results might be useful in promoting therapeutic interventions to support victims and to decrease the dysfunctional cognitions of sex offenders [ 16 ].

1.2. Sexual Addiction and BDSM among Survivors of Childhood Sexual Abuse

Several authors have reported that 80% of people [ 17 ] who experienced child sexual abuse (CSA) developed compulsive sexual behavior and sexual addiction in adulthood. Pereira et al. [ 18 ] confirmed the relationship between childhood sexual abuse and a later disposition toward compulsive sexual behaviors. They found that sexual abuse experiences and poor family relationships during childhood enhance vulnerability to initiating and maintaining out-of-control sexual behaviors. They confirmed this association, with a prevalence in the male population that seems to be more susceptible to the development of sexual addiction and compulsion. Thus, this behavior is a transversal phenomenon that vulnerable people can use to manage intense and negative emotions related to the distress of abuse [ 19 ].

The experience of women with sexual compulsivity is intensely shame-based and difficult to deal with. The family preconditioning of abandonment in childhood emerges through inadequate care, experiences of abuse, abandonment, and the presence of other addictions, as shown by case studies analysis [ 20 , 21 ]. As children, these women were looking for something to ease their distress when they could not rely on their caregivers. Mostly, they use maladaptive coping mechanisms, such as compulsive masturbation, binge eating, and violent fantasies, to maintain their sanity in childhood.

According to Freud’s theory, at the basis of this behavior might be a trauma suffered by the children caused by the experience of impotence and the contact with a threatening adult [ 22 ]. This experience triggers strong anguish in the face of which the child activates a series of defenses to protect themselves, including the conversion of the trauma and identification with the aggressor. These modalities convert, to quote Stoller, “the infantile trauma into an adult triumph” [ 23 ].

Sexual atypia and paraphilias lead to reliving the traumatic experience while preserving the illusion of control and sexual gratification, which provides individuals with a false sense of power that preserves their integrity. The strong aggression and anguish distort the vision of the other, who becomes a dehumanized object. This is the mode implemented to cope with strong emotions derived from traumatic experiences [ 24 ].

Indeed, at the origin of masochism, there could be an infantile experience of passivity and annulment. In this case, the mechanism of reversal of the experience undergone is structured as a masochistic defense. In the adult re-perpetration of the trauma staged in the perversion, the person is no longer the passive victim of an executioner but the holder of control. It is the subject who asks the executioner to suffer and to be objectified. This perception gives masochistic pleasure to the person. From this point of view, the masochist’s pain is a defense against the greater and deeper pain of rejection [ 22 ].

In this way, sadomasochistic sexual practices could assume a key role in sexual trauma processing. BDSM (slavery and discipline, domination and submission, sadism and masochism) is receiving increasing attention from the scientific community. The term BDSM identifies a wide range of erotic practices between two or more consenting partners who share sexuality based on games of power, dominance, and submission from which they derive satisfaction and pleasure. Today, the BDSM phenomenon is viewed from a biopsychosocial perspective [ 25 ].

Studies show a positive correlation between BDSM interests and personality traits, adverse childhood experiences, education levels, sexual orientation, and biological indicators. The limitations of the research lie in the fact that most studies so far are only descriptive [ 26 , 27 ]. Some researchers have focused on better understanding the aspect of pain within a BDSM interaction [ 28 , 29 ], as experiencing afflicting or receiving pain is a relevant part of BDSM interaction. The result is that BDSM practitioners seem to have a higher pain threshold overall and, specifically, submissive BSDM interaction results in a constant increase in pain thresholds [ 28 ].

Further research focused on the rewarding biological mechanism associated with BDSM interaction. They found that submissive practitioners showed increased cortisol and endocannabinoid level due to the BDSM interaction, while dominant practitioners only showed increased endocannabinoid levels when the BDSM interaction was associated with power-plays [ 30 ].

1.3. Strategic Counseling

Strategic counseling is an intervention that refers to the theory of strategic psychotherapy and aims to reach a specific goal through techniques based on communication. Strategic counseling is efficient in modifying patients’ points of view and in promoting the solution of their issues [ 31 , 32 ].

Strategic counseling is effective in managing personal, relational, and working problems. One of the most important characteristics of strategic counseling is the focus on the function and the dynamic of the issue (“how my problem works”), instead of on the causes (“why I have a problem”). The focus is on the present and the future and not on the past, which represents a starting point to assess patients’ cognitions [ 33 ]. According to the process of strategic counseling, there are solutions as well as problems and these solutions are strongly related to the characteristics of the issue, akin to a dress tailored to the patient. Strategic counseling is a flexible type of counseling—it adapts to the specific problem until it leads the person to perceive the problem differently and therefore to change their behavior. The most used element of strategic counseling is communication, the so-called “strategic dialog” [ 34 , 35 ].

Strategic communication is characterized by a series of techniques that lead people to discover new ways of perceiving and managing problematic situations. Therefore, strategic dialogue leads to an experience of changing one’s own feelings and perceptions, modifying one’s perspective. Strategical problem solving is one of the most common techniques, which we could define as the “technology” to find solutions because of its effectiveness in finding alternatives [ 36 , 37 , 38 ].

Finding alternative solutions to a problem is not easy and leads to implementing the usual solutions, the so-called “attempted solutions”, but which turn out to be unsuccessful, only increasing the sense of inadequacy and dissatisfaction [ 39 ]. The attempted solutions have the function to maintain the problem and to create a vicious circle in which the person is psychologically trapped.

Strategic problem solving modifies the dynamics of rational linear thinking to find the solution, through stratagems of non-ordinary logic. This allows finding a solution in the present rather than an explanation in the past [ 38 ].

Therefore, strategic counseling is characterized by its flexibility and adaptability to the problem presented, since it makes use of strategies and techniques conceived and adaptable to the established purpose. Indeed, as the counseling intervention proceeds, it can be reoriented based on the observed effects. This intervention method guides clients to change their behavior, their feelings about the problem, and the perception of events, changing their perspective of observation and feelings connected to the problem. Clients experience new perceptions and discover different ways to manage and overcome difficulties. These sensations and perceptions become actions and behaviors that lead to higher individual awareness. According to this perspective, behavior change derives from a modification of perceptions that simultaneously generate a different way of conceiving and relating to reality or “to change to know” [ 35 ].

1.4. Strategic Behavioral Prescriptions

Prescriptions are tasks and indications that the therapist provides during the sessions. The patient must perform these tasks between sessions or during the session itself. In strategic counseling, behavioral prescriptions represent an important function, since to bring about a change one must go through concrete actions, acting on the problem even in the absence of the therapist [ 40 ]. This absence allows patients to demonstrate that they can change their situation from a concrete experience. Prescriptions can be direct, indirect, and paradoxical [ 41 ].

In the first case, these are clear indications about the actions that the patient should perform. These aim at achieving a specific and shared goal in the session. Collaborative patients with low resistance benefit from this type of prescription.

Indirect prescriptions are behavioral injunctions that hide their true goal and circumvent the individual’s resistance. These prescriptions are best suited to those who resist changing. They act persuasively through linguistic and hypnotic suggestions. The therapist shifts the patient’s attention from the problem to other elements that reduce the tension linked to the discomfort, allowing the individual to neutralize the problem.

The paradoxical prescriptions, on the other hand, provide for the use of the symptom of resistance to therapy, as actions to be voluntarily implemented or exasperated to increase the level of control perceived by the patient about a previously spontaneous situation [ 41 ].

The therapist reinforces the results obtained by the patients, redefining the situation and gratifying them [ 42 ]. Prescriptions play a key role in strategic counseling and are part of the change process as they create a bridge between the patient’s reality and the therapeutic setting.

2. Materials and Methods

2.1. procedure.

This case report illustrates the story of Sara, an Italian girl of 17 years of age. Sara suffers from BDSM-type sexual addiction, self-aggressive behavior, and alcohol abuse because she was a victim of sexual harassment when she was a child. Sara was involved by her mother in a strategic counseling program. The strategic counselor (SC) was a young woman, and the therapeutic process was divided into 15 weekly sessions which were 60 min long, as described in Table 1 :

Strategic counseling sessions and objectives.

2.2. Ethical Statement

Sara and her mother were informed by the strategic counselor that the therapy will be part of a scientific publication. The aims, the methods, and the procedure were explained to the minor and her mother in verbal and written forms. The SC obtained the informed consent of the participants to publish the therapy in online and paper journals. The participants were aware that their sensitive data (names, places, etc.) would be subject to change to protect privacy.

The informed consent was redacted according to the Italian Deontological Code of Psychologists of the National Council of the Order of Psychologists 2020 ( www.psy.it ) (accessed on 10 May 2021) and was based on the following Italian legislative references: Law 633/1941 Article 96 (Protection of copyright and other rights related); Civil Code Article 10 (Abuse of the image of others); Civil Code Article 23 (Consent for personal data processing); Legislative Decree n. 196/03 Article 13 and EU Regulation 2016/679 (GDPR) Article 13 (Information on the processing of personal data).

The collected materials are kept confidential under the responsibility of the SC.

3. Case report: Sara’s Story

3.1. assessment and therapeutic alliance.

Sara goes to art school, she is an only child and has lived alone with her mother since her father left home when she was 10. Sara was involved in the strategic counseling process by her mother, worried about her daughter’s high-risk behaviors, such as engaging in sex with several occasional partners and binge drinking.

Although it is not her direct request, Sara immediately demonstrates a good motivation to undertake the therapeutic path. Moreover, despite her young age, Sara shows good awareness of her psychological, physical, and cognitive state, expressing her feelings and thoughts.

During the first session, the strategic counselor invites Sara’s mother to attend. However, Sara shows considerable difficulty in talking about herself in the presence of her mother, so the SC decides to be alone with Sara. In the absence of her mother, Sara discloses with the SC, although with slight difficulty, describing her problem in relations with other, especially males, and telling the SC about the trauma she experienced when she was six, namely a sexual assault by a man of 20. Sara expresses embarrassment and shame in telling of her traumatic experience, holding her head, avoiding the therapist’s gaze, and never using the word “rape”. Sara also affirms that since she was 12, she has had violent sexual intercourse and bondage relationships with peers. Furthermore, when she decides to have sex with someone, she also binge drinks alcohol. Sara’s mother is unaware of her daughter’s trauma and believes that her daughter’s destructive attitudes are part of her adolescence. Sara describes her mother as a “normal, slightly apprehensive housewife”. She considers her childhood quite happy. However, when she was very young, her mom went through a particularly intense moment of emotional distress due to numerous conflicts with her father, which is why she often had to care for her ailing mom. For this reason, Sara decided to avoid telling her mother about the sexual violence.

The SC uses the techniques of active listening and lets all the elements emerge that the girl is ready to share. At the end of the session, the SC thanks Sara for the trust and courage shown and gives the girl a task, called “my objectives”. According to the prescription, she is required to describe the personal goals which she wants to obtain by means of the therapy.

During the second session, Sara comes alone. She sits and starts to read the task without any encouragement from the SC. Sara identifies her sex life as a source of discomfort. Her sexuality is characterized by strong and uncontrollable impulses, which lead her to seek out sexual acts and physical violence. When she has these impulses, she often contacts some friends who practice BDSM, namely bondage (not professional), and she asks them to have violent sexual intercourse, after binge drinking. Her mother discovered her activity when Sara came home one night with marks and bruises all over her body. On that occasion, Sara admitted to her mother that she has a problem managing her sexuality and that she explicitly asks her partners to practice bondage and to inflict upon her asphyxiation and physical violence. The girl explains that this kind of suffering gives her the feeling of control, as she is the one who decides to feel pain and the level to which she does so. An aspect that Sara realizes in completing the prescription is that when she had homosexual intercourse, she never felt the need to suffer violence. With boys, however, she sought violence during penetration and, in particular in practicing bondage. Sara realizes that her sexual impulses never allowed her to have a relationship and she describes sex as a punishment that she uses because she thinks she does not deserve to be loved.

The SC and the patient identify the main objectives of the therapeutic process as elaborate on the trauma deriving from sexual abuse suffered in childhood, exploring sexuality without the use of alcohol or violence, and structuring a new self-image considering her desires and resources.

During the third session, the SC describes to the patient the process of trauma processing, explaining the role of repressed emotions and memories. Despite the fear of reliving her trauma, Sara shows a strong motivation to continue the process, saying that she stopped her sexual impulses after her mother discovered them. Additionally, Sara admits that during those nights in which she practiced bondage, she felt that she could have suffocated. That event impacted the perception of Sara towards her sexuality, leading her to relive the same fear she felt during the abuse she suffered. Sara is not ready to tell her mother the truth. However, she does not exclude the possibility of doing this in the future.

It appears immediately functional for Sara to have a young female figure as a therapist to project and analyze some dynamics of her behavior without fear of being judged and to gradually acquire confidence.

3.2. Sexual Violence-Trauma Processing and Positive New Identity Structure

The second part of the therapeutic process was focused on trauma-processing and on the possible evaluation of the dysfunctional coping strategies used by Sara to manage her negative feelings connected to the traumatic experience. First, Sara was instructed to explore the dynamics of her trauma, learning how to change the memories linked to the experience. Sara explored her body’s reaction during her processing of trauma, and she also understood what happens in talking about her sexual violence. She analyzed her physical and emotional reactions, living and exploring the situation in the therapeutic setting. The second step of the trauma-processing was to lead Sara to tell her traumatic story from multiple points of view, exploring it as if she could relive it but from the outside, as an observer. The goal was to teach Sara, progressively, how to understand the emotions connected to the trauma and be able to face them, and then live the experience as a story that is part of her life but that can no longer hurt her because it belongs to the past. To reach this goal, the SC gave to Sara a specific prescription: “imagine that you can do something to make your current condition worse, imagine the worst fantasy on your traumatic experience”. This prescription leads the patient to realize that she has control over the decision-making process about her malaise and to analyze all the attempted solutions she has implemented and continues to implement even though they are dysfunctional, to solve her problem.

At first, Sara expressed difficulty in imagining how her traumatic experience could have been worse; however, later she created alternative scenarios that saw her capable of worsening her fantasy about the past and about the present. Sara gained more control over her choices and realized that self-harm related to extreme sexuality and alcohol abuse stems from this idea of not having control over her body, as someone else has it instead. When she carries out these harmful behaviors, she allows another person to harm her, and this removes her responsibility and reduces her sense of guilt for not having protected herself during the aggression suffered as a child.

Sara analyzed her relationship with alcohol and stated that what she appreciates most is the sense of relaxation and the absence of tension. However, once this effect is over, Sara suffers a psycho-physical breakdown, sadness, and a sense of emptiness. The substance, therefore, mitigates the anxiety of the girl, who slowly undertook to reduce its use to monitor the effect that these changes in behavior have on well-being. Additionally, Sara practices bondage during sexual intercourse, and she feels very protected and accepted and can share an aspect of herself that is more complex to externalize. Sara does not share this aspect of her life with her mother and feels it is not understood. After she started the therapeutic path, however, Sara became more confident in her relationship with her body, asking her mother for advice and support.

The SC explained to the patient that she should not aim to reach a socially shared normal range, but the goal is to understand its functioning and progressively reduce everything that causes her discomfort. Bondage-related BDSM experiences are denial and defense mechanisms that Sara uses, along with alcohol, to avoid dwelling on her suffering. The two thematic areas, bondage and alcoholic binging, are intertwined during the sessions. These draw a parallel between the desire, the effects, and consequences of alcohol and the violent sexual experiences Sara sought. These two conditions have in common the associated emotions and the subsequent intense sense of emptiness and sadness. Sara now hypothesizes that she can do without the search for risky or self-harming situations and for the first time she reflects on the meaning that these actions have for her, as she said: “I thought I was in control by drinking and doing violence to me, but it was my addiction to violent sex and alcohol that had control over me”.

The SC explained to the patient the theory of the “self-fulfilling prophecy”, asking her to reflect on how she could change this prophecy. The last four sessions before the therapeutic restitution and closing phase were focused on the building of a new positive identity structure. Sara was required to learn and apply strategies to (a) monitor her psycho-physical sensations related to self-harming behaviors, alcoholic binges, and bondage, understanding the relationship with her emotions; (b) learn to respect her body more and to assume control of her decisions, passing from a passive to an active role; and (c) find alternatives to violent sexual behaviors.

To achieve these aims, the SC gave to Sara the following prescriptions:

• (a) A diary of emotions, structured to analyze the type of emotion, the antecedent, thoughts, actions, strategies, and consequences and to become more curious and attentive toward her feelings and reactions.
• (b) The use diaphragmatic breathing once per day, to get in touch with her body, focusing on physical needs.
• (c) Dedicating some time to her sexual pleasure, identifying new activities and modalities as alternatives to violent bondage, associated with alcohol abuse.

Regarding the first prescription, during the sessions, Sara reported having monitored her emotions related to negative feelings and the need to self-harm through sex and alcohol as her coping strategies. She described some events in which she felt alone and misunderstood by her mother or friends. However, analyzing the situations, she found inconsistencies between her interpretation and the reality, understanding how often she tends to blame others for her malaise. Doing this exercise every day and illustrating to the SC all the reported events and emotions, Sara progressively recognized that she has mental patterns that lead her to perceive others as threats and to feel misunderstood and alone. Her strategy is always to make others abuse her to confirm her attribution of guilt.

Sara is now more aware of the way she uses violent sex and alcohol and the psychophysical consequences that come with it. This careful analysis of her behavior, together with the other two prescriptions, allowed the girl to get in touch with the needs of her body, to focus on physical and sexual well-being, without feeling negative emotions and guilt or punishing herself sexually with bondage. In fact, during the weeks between sessions, Sara learned to dedicate herself to the well-being of her body and explored other activities related to sexual pleasure that did not involve the use of violence, such as masturbation and petting, only with people of who she trusts. Additionally, Sara progressively talked with her mother, telling her about her progress.

The emotions during the task related to the exploration of sexuality were positive, as Sara was able to give herself something satisfying. A very interesting and adaptive sensation for the patient’s functioning is that she felt pampered and protected by herself during masturbation and by her sexual partner during petting. Sara also decided to no longer engage in sexual activities that result from negative emotions. Bondage for her will always be an aspect of her sexuality but she wants to be able to decide and not let her trauma take over.

The new ways of exploring sexuality that Sara learned required considerable effort. Sara was very brave and found a personal space in which to find her own new identity. These sensations are new for her, as Sara has never explored her body or recognized her sexual needs, if not mediated by violence. The contact with the body, now experienced positively, reduces the sense of shame.

The SC positively reinforces Sara’s need to find herself, reflecting on her resources. Sara has already found her inner space, she just has to keep feeding it in order to not fall back into the old dysfunctional strategies. To do this, Sara needs to continue with the prescription for another two weeks, in which she will explore her autonomy from the SC. Sara can contact the professional if she needs to, but she does not come to the counselor’s office for two weeks. In addition, the SC gives Sara another prescription, to add to the previous ones: “What I want when I want”. According to this behavioral task, Sara will do something that she desires to do, just to experiment with the pleasure of doing this. Sara can do more than one thing, but she must do at least one per day.

3.3. Therapeutic Restitution and Follow-Ups

This conclusive part of the therapeutic process aims to reinforce the positive outcomes obtained by the patient and to restitute feedback on the acquired strategies for the future. To reach these goals, the SC used the suitcase metaphor, comparing the therapeutic experience to a journey during which Sara learned some coping strategies useful to manage stressful events and to better organize her new life and identity. The patient imagines having a suitcase in which she can collect and take these strategies with her, to cope with difficulties and to maintain her outcomes.

During the last session, the SC asked Sara to describe her therapeutic process, looking to herself as an observer and pointing out the main changes and results obtained. Sara was enthusiastic to describe her improvements. She reported some actions done for the “What I want when I want” prescription, such as spending time with friends, reading books, and taking long walks. Sara did not show any negative feelings, such as shame or embarrassment, in admitting her old habits and in recounting the trauma experienced in childhood. She now is more aware and less afraid of her impulsive and destructive behaviors and aims to build a “true” identity, not being influenced by the violence suffered. Sara, however, expresses her fear of falling back into the dysfunctional behaviors and harming herself again.

The SC explains therefore that the therapy foresees two follow-up sessions, one after one month and one after three months. These sessions are aimed at monitoring Sara’s progress and helping her to maintain them over time. This perspective reassures the patient, who greets the SC with affection and gratitude. The SC also explains to Sara that in the month in which they will not see each other, she will have the sole task of using the tools learned in therapy, metaphorically opening her suitcase, and pulling out the ones that best suit the situation she must deal with.

After one month, the SC meets Sara and she tells the professional about her progress. During the month, the teenager often confronted her mother, explaining her problems and asking for help when she felt aggressive impulses. The mother responded adequately to her daughter’s requests, showing herself to be present and welcoming. Sara also tells of having opened her suitcase on several occasions and having used some strategies learned in therapy. Sara decided to continue to explore her sexuality through masturbation and petting and only with people she trusts. She did not experiment with compulsions regarding sexuality or binge drinking, and she started to practice sport (running) to take care of her body. During the session, the SC reinforced the prescription of the suitcase, adding the task to identify other tools and strategies to add to it.

Three months later, the SC conducted the last follow-up with the patient. During the session, Sara was excited to tell the SC her improvements. Indeed, she was selected to participate in a competitive run, and she also had her first sexual intercourse without the use of violence or bondage. Sara felt satisfied with her progress and she also added a tool in her suitcase: get in touch with her physical sensations. Sara started to concentrate more on her body and her physical needs. The SC compliments Sara and positively strengthens her progress. The counselor asks her to continue filling her suitcase with useful strategies and tools for her future.

4. Discussion

According to the definition of child sexual abuse, sexual harassment can be described on a continuum of power and control from non-contact sexual assault to contact sexual assault [ 4 ].

This phenomenon is widespread among children; indeed, one out of two children per year worldwide suffers some form of violence [ 43 ].

The recent scientific literature on sexual abuse shows that the consequences of this traumatic event jeopardize both the physical and psychological health of the individual and cause lifelong distress. The gradual emergence of symptoms following exposure to traumatic events represents a conceptual challenge for psychology and psychiatry. Indeed, child sexual abuse is associated with mental health issues, drug or alcohol addiction, and post-traumatic stress disorder [ 4 ].

This work aims to explore the possible relationship between experiences of childhood abuse and the development of pathological compulsive sexual behavior, sexual addiction and BDSM conducts. These pathological sexual behaviors are characterized by inappropriate or excessive sexual acts or cognitions that lead to subjective distress or impaired functioning.

Sadomasochistic sexual practices are receiving greater attention from the scientific community than in the past. The acronym BDSM identifies a wide range of erotic practices between two or more consenting partners who share sexuality based on games of power, dominance, and submission from which they derive satisfaction and pleasure. Risk factors are thought to include family history and childhood abuse, and it seems that compulsive sex and BDSM practice represent a functional behavior to compensate for the traumatic experiences of abuse [ 44 ].

The case report illustrated herein shows an association between sexual violence and risky behavior in adolescence. Sara is a 17-year-old adolescent who suffered sexual violence when she was six and developed a sexual addiction relating to BDSM (bondage) and binge drinking. The mother of Sara, worried about her daughter, introduces Sara to the strategic counseling process. The SC sessions were divided into 15 sessions with specific goals and prescriptions. At first, Sara revealed her story, talking of the sexual abuse and of the tendency to have violent sexual intercourse, to practice BDSM, specifically bondage, and to drink alcohol before sex. The first step of strategic counseling’s process (three sessions) was to focus on the assessment and on establishing a therapeutic alliance. Specifically, the SC created a therapeutic alliance with the patient, who learned to manage negative emotions related to the abuse. Sara associated herself with the counselor, a young woman, and established a strong relationship of trust. The patient and the counselor used this positive relationship to co-build objectives for the other steps of the therapy.

The second (five sessions) and the third steps (four sessions) were focused on sexual violence-trauma processing and had the aim of elaborating the memories related to the trauma and on building a new identity. In this phase, Sara analyzed her relationship with alcohol and BDSM. She understood the role of substance abuse and violent sex in her life. Indeed, on the one hand, alcohol and sex mitigate the feeling of anxiety and she feels invincible, but on the other hand, Sara perceives a sense of shame and guilt. During this process of evaluation of her coping strategies, Sara started to communicate with her mother, asking for support. The SC guided Sara to discover more functional strategies for her well-being. The counselor explained the theory of the “self-fulfilling prophecy” and encouraged Sarah to make a positive prophecy about herself come true. At the end of this phase of counseling, Sara learned to monitor her psycho-physical sensations related to self-harming behaviors, alcoholic binges, and bondage, understanding the relationship with her emotions, and to respect and explore her body more, assuming the control of it and being active, as well as in her sexuality. These skills led Sara to find alternatives to violent sexual behaviors.

The final step (one session) was based on the therapeutic restitution and the SC positively reinforced the outcomes of the therapeutic process and restituted feedback on the acquired strategies for the future. To do so, the SC used the metaphor of the suitcase, according to which Sara can collect the strategies she learned into this suitcase and she can open it and use them anytime she feels the need.

The SC performed the first follow-up one month after the end of the therapy and a follow-up after three months. During both follow-ups, Sara demonstrated having maintained the positive outcomes of the therapy and using her suitcase to cope with difficulties. Sara practiced sport and stopped using BDSM, violent sex, and alcohol. Today, her relationship with sexuality is based on self-eroticism and petting with people she trusts.

5. Conclusions

The review of the literature and the case report presented highlighted the importance of exploring the possible connection between childhood sexual abuse and the development of compulsive sexual behavior and BDSM practices in adulthood. The recognition that comes from relationships with others (partner, sexual interest, work) confirms the value of our existence. Consequently, some individuals could undertake their search for contact through the forced transition from the passive to the active role, displaying risky behavior concerning fears and life experiences.

Hypersexuality and sadomasochistic practices might compensate for the missing part of the subject’s ego. The pain of self-esteem’s loss, parental affection, or childhood omnipotence is anesthetized through perverse action and fantasy. Sexual practices based on violence and coercion in some cases allow individuals to act out their fantasy of perfection. In this act, the sadist is reunited with his/her lost omnipotent self and the masochist abandons himself/herself in the other, rediscovering the fusion condition of childhood.

This division between reality and fantasy, between loss and the denial of grief, is also reflected in the thinking of these subjects as an inability to accept different views, without considering nuances or a middle ground.

Author Contributions

Conceptualization, V.S.; writing—original draft preparation, V.S., E.Z., S.E., M.P.; writing—review and editing, S.E., V.S.; supervision, V.V.; funding acquisition, V.V. All authors have read and agreed to the published version of the manuscript.

This research was published thanks to the contribute of the Institute for the Study of Psychotherapies, Rome, Italy; and the Department of Human, Social and Health Sciences of the University of Cassino and Southern Lazio, Cassino, Italy.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Institute for the Study of Psychotherapies, Rome on 26 April 2018.

Informed Consent Statement

Written informed consent has been obtained from the patient(s) to publish this paper.

Conflicts of Interest

The authors declare no conflict of interest.

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