¿En qué se diferencian las agresiones sexuales cometidas en solitario y en grupo? Una revisión sistemática / How are solo versus multiple perpetrator sexual assaults different? A systematic review

Resumen El estudio de las agresiones sexuales ha tenido una gran relevancia e interés en la literatura. Las agresiones sexuales en grupo representan una pequeña proporción de todas las agresiones sexuales cometidas, pero presentan unas características específicas. La presente revisión sistemática examinó las variables de los delitos de agresión sexual cometidos en solitario versus en grupo. Se realizó una búsqueda bibliográfica en las bases de datos Psycinfo, Academic Search (EBSCO) y Google Scholar, y se encontraron ocho documentos que cumplían las condiciones de inclusión. Los resultados muestran que existe evidencia de las diferencias cualitativas entre las agresiones sexuales cometidas según el número de infractores. Las dinámicas que se promueven en los grupos explican la participación de los sujetos en las agresiones sexuales en grupo. El comportamiento colectivo favorece las agresiones sexuales en grupo por los procesos inherentes a él. Los delincuentes son, en su mayoría, hombres. Los delincuentes solitarios tienen una mayor edad y, a medida que los grupos son más grandes, la edad de los agresores disminuye. En cuanto a las víctimas, son más jóvenes que los agresores, sobre todo en los casos perpetrados por múltiples sujetos, y ofrecen una mayor resistencia ante las agresiones en solitario. Se ha confirmado que en las agresiones en grupo se llevan a cabo más actos sexuales y se utiliza más la violencia. Por otro lado, no aparecen diferencias en cuanto al uso de alcohol y la presencia de armas en las agresiones. Estos resultados tienen implicaciones para la prevención del delito y el tratamiento de las víctimas.

Abstract The study of sexual assault has had great relevance and interest in the literature. Group sexual assaults represent a small proportion of all sexual assaults committed, but they have specific characteristics. Internationally, it is established that between 10 and 33 % of sexual assaults have been committed by multiple authors. Describing the differences between individual versus group sexual assaults has been a challenge for researchers. The literature has concluded that there is a difference in the etiology of sexual assaults committed according to the number of authors. While in solo sexual assaults personal vulnerability factors may explain why these crimes are committed, in group assaults group behavior dynamics explain the interaction between more subjects. This systematic review examined the variables of sexual assault crimes committed alone versus in a group. A literature search was conducted on the Psycinfo, Academic Search (EBSCO) and Google Scholar databases. In the first analysis a total of 34 studies were initially identified, and after filtering the reasons for exclusion the analysis was performed with eight investigations. The results show that there is evidence of qualitative differences between sexual assaults committed according to the number of offenders. The dynamics promoted in the groups explain the subjects' participation in group sexual aggressions. Collective behavior favors sexual aggressions in groups because of the processes inherent to the group. The most common group was two subjects (dyad) although the average group was usually composed of three subjects. The offenders are mostly men; the lone offenders are older, and as the groups become larger, the age of the offenders decreases. Research has shown that the majority of victims are female, both in single and group assaults. Victims are also younger than the perpetrators, especially in multi-subject attacks, and they are more resistant to single-aggression attacks. The place where the crime is committed presents significant differences. Some authors found that offenders in groups of three or more people often commit the assault in an indoor space, although others found that lone offenders were more likely than group offenders to rape the victim indoors, especially in the bedroom. It has been confirmed that in group aggressions more sexual acts are carried out and more violence is used. Vaginal penetration is the most committed sexual assault, followed by anal and oral rape. In all cases, vaginal rape is more prevalent among group sexual assaults, even more so when the assaults are committed by groups of three or more subjects. Studies of multiple perpetrator sexual assaults show that this type of act increases the probability of suffering more injuries and long-term health problems. Another conclusion that can be drawn is that there are significant differences in the timing of stranger assault, with a higher likelihood of a stranger assault in group rapes. On the other hand, there is also a relevance in the presence of other instrumental factors such as alcohol and weapons. As for alcohol, it showed a significant relationship in sexual assaults. Although the presence of weapons in sexual assaults is not very common, some research has confirmed that groups tend to threaten victims with a weapon to a greater extent, and the knife is often the most common weapon. The results found are particularly relevant to understanding sexual assault crimes and have implications for crime prevention and the treatment of victims.

Adherencia o deserción de adolescentes en psicoterapia por agresiones sexuales: la perspectiva de sus terapeutas / Adherence or Drop Out of Adolescents in Psychotherapy Due to Sexual Abuse: their Therapist's Perspective

Resumen Un alto porcentaje de adolescentes que asisten a psicoterapia por haber sido víctimas de agresiones sexuales desertan de su tratamiento, afectando así su proceso de superación. Existe escasa investigación respecto a qué precipita la deserción o favorece la adherencia en estos casos. Objetivo: describir características del sistema consultante y del proceso psicoterapéutico de adolescentes que han sido víctimas de agresiones sexuales que adhieren y que desertan de la psicoterapia, desde la perspectiva de sus psicoterapeutas, explorando sus similitudes y diferencias. Método: se realizaron entrevistas semiestructuradas a psicoterapeutas que atendieron 16 casos de adolescentes que han sido víctimas de agresiones sexuales, 8 que desertaron de la psicoterapia y 8 que adhirieron hasta el alta. Se realizó un análisis narrativo temático de las entrevistas. Resultados: las principales similitudes identificadas fueron contextos sociofamiliares multiproblemáticos, recursos personales en los adolescentes y una relación psicoterapéutica positiva. Las diferencias se enfocaron en los adultos responsables, quienes en los casos de deserción mostraban bajo apoyo, una relación más conflictiva con el adolescente, escaso involucramiento en la psicoterapia y una relación frágil con el psicoterapeuta. Los adolescentes que desertaron presentaron motivos de consulta no asociados con la agresión sexual y se caracterizaron por ser socialmente poco integrados, a diferencia de los que adhirieron. Discusión: los fenómenos de adherencia y deserción a psicoterapia son complejos y multifactoriales. Junto con factores asociados al sistema consultante, se destacan elementos del proceso psicoterapéutico que propician la adherencia, y que, por tanto, pueden ser abordados tempranamente para favorecer la adherencia a la psicoterapia.

Abstract A high percentage of adolescents who attend psychotherapy due to sexual abuse drop out of treatment, affecting the overcoming. There is little research on what precipitates desertion or promotes adherence in these cases. Aim: describe features of the consulting system and the psychotherapeutic process of adolescents who have been sexually abused who adhere and drop out of psychotherapy, in order to explore similarities and differences from the perspective of their psychotherapists. Methods: Semi-structured interviews were conducted with psychotherapists who attended 16 cases of adolescent victims of sexual abuse, 8 who deserted from psychotherapy and 8 who continued until discharge. Thematic narrative analysis of the interviews was developed. Results: the main similarities described were multiproblematic social and family contexts, personal resources in the adolescents and a positive psychotherapeutic relationship. Differences were focused on caretakers, who in the drop out cases showed low support and a more conflictive relationship with the adolescent, little involvement in psychotherapy and a poor relationship with the psychotherapist. Adolescents who deserted had consultation purposes not related with sexual abuse and low social integration, unlike those who adhered. Discussion: the phenomena of adherence and dropout of psychotherapy are complex and multifactorial. Along with factors associated with the consulting system, elements of the psychotherapeutic process that support adherence stand out, which can be addressed early in the process.

Pensamentos de risco de um adulto autor de violência sexual / Risk thoughts of an adult perpetrator of sexual violence / Pensamientos de riesgo de un adulto autor de violencia sexual

Trata-se de pesquisa qualitativa sobre os pensamentos de risco (fantasias sexuais) de um adulto ofensor sexual (55 anos, cumpriu pena restritiva de liberdade) atendido em uma instituição pública de saúde. Buscou-se, por meio de pesquisa documental, conhecer o desenvolvimento das fantasias sexuais em relação ao assédio sexual. O contexto foi o de uma instituição de saúde, e o foco foi o assédio a três vítimas meninas (oito, nove e 10 anos). As informações foram coletadas em uma entrevista que teve a duração de duas horas. Realizou-se a leitura das informações sobre os pensamentos/fantasias que surgem diante de um possível assalto sexual a uma criança e/ou adolescente. A discussão versou sobre: o pensamento de risco; as reações da vítima; e o processo de justificativa para a ação violenta. O conhecimento dos pensamentos de risco devem fazer parte de qualquer intervenção com essa população de ofensores sexuais adultos e ser visto como parte do circuito protetivo de crianças e adolescentes.

This is a qualitative research (documentary analysis) on the risk thoughts (sexual fantasies) of an adult sexual offender (55 years old, who served a restrictive sentence of freedom) attended in a public health institution. We sought, through documentary research, to know the development of sexual fantasies concerning the behavior of sexual harassment. The context was in a health institution, and the focus was the harassment of three female victims (eight, nine and 10 years old). The information was collected in an interview that lasted two hours. Information about the thoughts/fantasies that came up in the face of a possible sexual assault on a child and/or adolescent was carried out. The discussion dealt with: risk thinking; the victim's reactions; and the process of justification for violent action. Knowledge of risk thoughts should be part of any intervention with this population of adult sexual offenders and be seen as part of the protective circuit of children and adolescents.

Se trata de una investigación cualitativa (análisis documental) sobre los pensamientos de riesgo (fantasías sexuales) de un adulto ofensor sexual (55 años, cumplió una pena restrictiva de libertad) atendido en una institución pública de salud. Se buscó, por medio de la investigación documental, conocer el desarrollo de las fantasías sexuales con relación a la conducta del acoso sexual. El contexto fue de una institución de salud, y el enfoque fue el acoso de las tres niñas víctimas (ocho, nueve y 10 años). La información fue recogida en una entrevista que tuvo una duración de dos horas. Se realizó la lectura de las informaciones sobre los pensamientos/fantasías que surgen ante un posible asalto sexual a un niño y/o adolescente. La discusión versó sobre: el pensamiento de riesgo; las reacciones de la víctima; y el proceso de justificación para la acción violenta. El conocimiento de los pensamientos de riesgo debe formar parte de cualquier intervención con esa población de ofensores sexuales adultos y ser visto como parte del circuito protector de niños y adolescentes.

Intervenção psicológica em vítimas de estupro na cidade de São Paulo / Psychological intervention in rape victim in the city of São Paulo / Intervención psicológica con mujeres que sufrieron estupro en la ciudad de São Paulo

A intervenção psicológica com vítimas de estupro é essencial para a reorganização psíquica da mulher. Este estudo objetivou analisar, por meio da experiência profissional de psicólogas, as especificidades do processo de intervenção terapêutica em mulheres vítimas de estupro. Foram realizadas entrevistas semidirigidas com cinco psicólogas que atuam em serviços públicos de saúde - hospitais e em Centros de Referência a vítimas de violência sexual - na cidade de São Paulo. Os resultados foram analisados por meio de análise de conteúdo. As vítimas ingressam no atendimento com vivências intensas de angústia, sentimentos de tristeza, vergonha, medo e culpa. Algumas profissionais fazem uso de procedimentos específicos como hipnose, inventários e técnicas projetivas. De modo geral, o trabalho psicoterápico, focal ou não, visa criar condições para que as vítimas superem o evento traumático e retomem sua rotina

Psychological intervention in rape victim is essential to woman's health and reorganization. This study aimed to analyze the specificity of the therapeutic intervention process in female rape victims through psychologists' professional experience. Semi-structured interviews have been carried out by five psychologists who work in the health service - hospitals and centers for attention to women victims of sexual violence - in the city of São Paulo. Results were analyzed through content analysis. Victims come to the health service with anguish, sadness, shame, fear, and guilt. Some professionals use specific procedures as hypnosis, inventories, and projective techniques. Altogether, the therapeutic work, being focal or not, aims to create conditions so that the victims can overcome the traumatic event and resume their lives routine

La intervención psicológica con víctimas de estupro es fundamental para la reorganización psíquica de la mujer. Este estudio tuvo como objetivo analizar, por medio de la experiencia profesional de psicólogas, las especificidades del proceso de intervención terapéutica en mujeres víctimas de estupro. Se realizaron entrevistas semi-dirigidas con cinco psicólogas que actúan en servicios públicos de salud - hospitales y en Centros Especializados para víctimas de violencia sexual - de la ciudad de São Paulo. Los resultados se analizaron mediante el análisis de contenido. Las víctimas empiezan el atendimiento con vivencias fuertes de angustia, sentimientos de tristeza, vergüenza, miedo y culpa. Algunas profesionales hacen uso de procedimientos específicos como hipnosis, inventarios y técnicas proyectivas. De manera general, el trabajo psicoterápico, focal o no, visa crear condiciones para que las víctimas superen el evento traumático y retomen sus rutinas de vida

Características y consecuencias de las agresiones sexuales en adolescentes consultantes en un centro de salud sexual y reproductiva / Characteristics of sexual assault and its consequences in adolescents at a sexual and reproductive health center

Antecedentes: La agresión sexual es un evento traumático y doloroso que afecta de manera transversal, a las víctimas de ambos sexos, de todos los niveles socioeconómicos con graves consecuencias para la salud física, psicológica y social para quienes la sufren. Objetivo: Determinar las características de las agresiones sexuales y sus consecuencias en adolescentes consultantes en un centro de atención en Salud Sexual y Reproductiva. Método: Estudio analítico de corte transversal de 573 adolescentes atendidas en un centro de medicina reproductiva (CEMERA) en el período 2003-2010 y que reportaron antecedente de abuso sexual. Se estudiaron tanto las características como las consecuencias del abuso, datos que se obtuvieron desde las fichas clínicas. Resultados: En el 86,5 por ciento de los casos se reportó abuso sexual y en un 13,5 por ciento violación. El 48,5 por ciento de los agresores son familiares. La edad más vulnerable fue entre 5-9 años con un 41,2 porciento. En el 39,2 por ciento el abuso sexual fue reiterado. En un 43,4 por ciento el lugar fue el propio hogar de la víctima. Un 70 por ciento reveló y de estos el 45,9 por ciento lo hizo en forma tardía. Sólo en un 19 por ciento se hizo la denuncia legal. De las adolescentes que iniciaron actividad sexual voluntaria (83,3 por ciento), un 35,4 por ciento tenía menos de 15 años. Un 11,8 por ciento reportó 3 y más parejas sexuales. Conclusión: El antecedente de abuso sexual debe ser considerado en la atención de adolescentes que consultan por salud sexual y reproductiva. El equipo de salud debe estar preparado para atender sus múltiples necesidades.

Background: Sexual assault is a traumatic and painful event, which affects victims of both genders, across all socioeconomic levels, with serious consequences for physical, psychological, and social health. Objective: Determine the characteristics of sexual assault and its consequences in adolescents at a sexual and reproductive health center. Method: Analytic and cross-sectional study of 573 adolescents seen at a reproductive medicine center (CEMERA) in the period 2003-2010 and who reported history of sexual abuse. Patient's clinical records were reviewed to study the characteristics as well as the consequences of sexual abuse. Results: The abuse was reported as sexual abuse in 86.5 percent of the cases and as rape in 13.5 percent. In 48.5 percent of the cases, the aggressors were relatives of the victims. The most vulnerable group is between 5-9 of age, representing 41.2 percent of the cases. For 39.2 percent of the cases, the sexual abuse was reiterative, and in 43.4 percent, the abuse took place on the victim's home. 70 percent of the victims told someone about the abuse; 45.9 percent of those revealed their abuse in a delay manner. Only 19 percent of victims filed a legal complaint. Of the adolescents who started voluntary sexual activity (83.3 percent) a 35.4 percent was under de age of 15, and 11,8 percent reported having 3 or more sexual partners. Conclusion: A history of sexual abuse must be considered in the attention of adolescents who consult for reproductive and sexual health. The health team must be prepared to address their multiple needs.

Gênero, saúde e adolescência: uma reflexão a partir do trabalho com a violência doméstica e sexual / Gender, health and adolescence: reflections starting from working with domestic and sexual violence / Género, salud y adolescencia: una reflexión a partir del trabajo con la violencia doméstica y sexual

A violência é uma realidade tão antiga quanto a humanidade e pode estar atrelada à “necessidade” de poder que é exercido contra a maioria ou minoria. Deparamo-nos com casos de espancamento e violência sexual que podem provocar morte e/ou deixar sequelas físicas e psíquicas para o resto da vida. Nesse cenário mórbido, as maiores vítimas são sempre crianças, adolescentes e mulheres. Para pensarmos na articulação entre Gênero e Adolescência, no âmbito da reflexão sobre violência doméstica e sexual, temos que entender que existe uma mediação entre essas duas questões. Baseamo-nos nos trabalhos de Burin (1987); nos estudos sobre gênero (Scott, 1995; Guedes, 1995; Saffioti, 1995) e sobre adolescência (Lavinas, 1997; Ozella, 2000; Peres, 1998; Saffioti, 1989, 1997). Já o atendimento individual e grupal a adolescentes inscritos no Programa de Atendimento a vítimas de violência - PEMA, do Hospital Universitário Bettina Ferro de Souza – HUBFS, nos fez compreender como as situações de violência têm possibilitado articulação(ões) entre gênero e saúde mental. Essas duas questões apontam pistas para Compreender as queixas e situações com que nos deparamos hoje no Trabalho de intervenção com Adolescentes vítimas de Violência Doméstica e Sexual - VDS.

Violence is as old as humanity it self. It can be reined to the power “need” exerted against majorities or minorities.We happen to find spanking and sexual violence instances that can bring about death and/or physical and psychicsequels throughout the remainder of people’s lives. In this morbid scenario most of the victims are children, adolescents and women. To consider the articulation between gender and adolescence as we reflect on domestic and sexual violence, we must understand that there is a connection between these two issues. We base ourselves in the works of Burin (1987); in the studies on gender (Scott, 1995; Guedes, 1995; Saffioti, 1995) and on adolescence (Lavinas, 1997; Ozella, 2000; Peres, 1998; Saffioti, 1989, 1997). Individual and social attention to adolescents registered in the Program of Attention to Violence Victims (PEMA, acronym for the program in Portuguese) of the Bettina Ferro de Souza University Hospital (HUBFS, acronym for the hospital in Portuguese) already made us perceive how violence situations are articulated to gender and mental health. These two issues give us cues to understand the situations and the grievances we face today in our intervention work with adolescents who have been victims of Domestic andSexual Violence (DSV).

La violencia es una realidad tan antigua cuanto la humanidad y puede estar arrendada a la “necesidad” de poder quees ejercido contra la mayoría o la minoría. Pudimos encontrar casos de palizas y violencia sexual que pueden provocar la muerte y/o dejar secuelas físicas y psíquicas para el resto da vida de las personas. En ese escenario mórbido, las mayores víctimas son siempre los niños, los adolescentes y las mujeres. Para pensar en la articulación entre Género y Adolescencia, en el ámbito de la reflexión sobre violencia doméstica y sexual, tenemos que entender que existe una mediación entre esas dos cuestiones. Aquí nos apoyamos en los trabajos de Burin (1987); en los estudios sobre genero (Scott, 1995; Guedes, 1995; Saffioti, 1995) y sobre adolescencia (Lavinas, 1997; Ozella, 2000; Peres, 1998; Saffioti, 1989, 1997). La atención individual y grupal a adolescentes inscritos en el Programa de Atención a Víctimas de Violencia (PEMA), del Hospital Universitario Bettina Ferro de Souza (HUBFS), nos hizo comprender como las situaciones de violencia posibilitan articulación/articulaciones entre genero y salud mental. Esas dos cuestiones sugieren pistas para comprender las quejas y situaciones que encontramos hoy en el trabajo de intervención con adolescentes víctimas de Violencia Doméstica y Sexual (VDS).