Substance abuse and childhood maltreatment. Conceptualizing the recovery process.

Research exploring the dual, yet related, issues of adulthood substance abuse and childhood maltreatment remains limited to the effects of such experiences on the individual. To date, clinical literature has failed to explore the ways in which individuals, particularly women, cope with and recover from these experiences. The current study applied a qualitative methodology to a sample of six women. Respondents had completed a minimum of 3 years of chemical-free living and self-identified as survivors of prolonged childhood sexual abuse. Women participated in a semi-structured interview to detail their recovery process. Results show support for a multifactorial process of recovery; specifically, strategies aimed at affect regulation, development of a new self-concept, and the forging of more adaptive attachment styles. The implications of these results are discussed in the context of improving clinical intervention strategies and encouraging additional research endeavors to understand this complex process.

Genital injuries following sexual assault of women with and without prior sexual intercourse experience.

BACKGROUND: The literature on sexual assault has not directly addressed the question of genital injuries in women without prior sexual intercourse experience. Given the paucity of research and the current importance of physical evidence in the criminal justice system, this study was designed to document the type and site of genital injuries from sexual assault in women without and with prior sexual intercourse experience. METHODS: The charts were reviewed of 132 women who had been sexually assaulted and had sought medical treatment at the Sexual Assault Care Centre (SACC), Women's College Hospital, Toronto, within 10 days after the assault. Half (66) of the women reported that, at the time of the assault, they had no prior sexual intercourse experience. The Sexual Assault Evidence Kit in each patient's file was reviewed to ascertain the type and location of genital injuries. Types of injuries were classified into 3 categories (nonperforating soft-tissue injuries, lacerations or current bleeding) and locations into 6 categories (labia majora and minora, posterior fourchette and introitus, hymen, vagina, cervix, and anus). RESULTS: Significantly more women without than with prior sexual intercourse experience had visible genital injuries (65.2% v. 25.8%, p < 0.01). However, of the women without prior experience, only 9.1% had hymenal perforation. Analyses of the data for only women with genital injuries indicated no difference between those without and those with prior sexual intercourse experience in the overall mean number of injured sites (1.65 and 1.47 respectively) or in the mean number of sites with nonperforating soft-tissue injuries (0.349 and 0.706), lacerations (0.953 and 0.471) and bleeding (0.279 and 0.294). INTERPRETATION: The results suggest that genital injuries are more common in women without prior sexual intercourse experience but that substantial proportions of all women, regardless of their prior sexual experience at the time of assault, will not have visible genital injuries. Emergency department staff and members of the criminal justice system need to be aware of the variable presentation of genital trauma related to sexual assault in women with and without prior sexual intercourse experience.

Comparison of sexual assaults by strangers and known assailants in an urban population of women.

OBJECTIVE: To examine the characteristics of sexual assaults by strangers and those by people known to the victims in an urban community-based population of women. DESIGN: Descriptive study. SETTING: Sexual Assault Care Centre, Women's College Hospital, Toronto. PARTICIPANTS: All 677 women who presented to the centre between June 1, 1991, and Sept. 30, 1993, and for whom the victim-assailant relationship was known. OUTCOME MEASURES: Assailant's relationship to victim, sex of assailant, number of assailants, number, type and location of assaults, use of weapons, type of coercion and extent of physical trauma or injury. RESULTS: Sexual assault by a person known to the victim accounted for 456 (67.4%) of the assaults reported. In 344 cases the person was known more than 24 hours; 99 (28.8%) were current or previous boyfriends or spouses. Assailants who were strangers were more likely to assault the victim more than once (t = -2.42, 355 degrees of freedom [df], p < 0.05), force the victim to perform fellatio (chi 2 = 8.63, 1 df, p < 0.005), use weapons (chi 2 = 12.01, 1 df, p < 0.001) and use physical coercion (chi 2 = 4.42, 1 df, p < 0.05), whereas assailants who were known to the victims were more likely to assault a woman who was sleeping or drugged (chi 2 = 10.38, 1 df, p < 0.005). Sexual assault by a known assailant was more likely to occur in the home of the victim (chi 2 = 36.27, 1 df, p < 0.001) or the assailant (chi 2 = 8.46, 1 df, p < 0.005), whereas sexual assault by a stranger was more likely to occur outdoors (chi 2 = 89.80, 1 df, p < 0.001) or in a vehicle (chi 2 = 32.81, 1 df, p < 0.001). Overall, the mean number of trauma sites was greater among victims assaulted by strangers than among those assaulted by people they knew (t = -4.29, 180 df, p < 0.001). CONCLUSION: Two thirds of the sexual assaults in this urban population were committed by people known to the victims, and over two thirds of these assaults were associated with physical trauma. Improved victim services and prevention strategies should be built on this knowledge.

The evaluation and treatment of sexual violence, necrophilia, and asphyxiophilia.

At first sight the phenomena discussed in this paper may seem to have little in common. Yet on close scrutiny it becomes apparent that there is an interesting degree of overlap. Although sexual assaults in general clearly involve multiple causes or factors, social and cultural as well as individual, many sexual aggressors do show psychological or biologic abnormalities which require careful evaluation. Continued empiric study of the variables discussed in this paper is therefore important. The clinical as well as laboratory study of paraphilias with dangerous tendencies to themselves or others is also essential for a better understanding of the causes and relationships between these disorders.

Group therapy for gender-dysphoric heterosexual men.

The treatment and clinical management of gender dysphoric heterosexual men often poses a challenge to the clinician. Gender dysphoric patients pursuing various lifestyle options may seek psychotherapy to deal with some of their conflicts. This paper describes one form of counseling--group therapy--which has been helpful to gender dysphoric heterosexual men and outlines the group psychotherapy program at the Gender Clinic of the Clarke Institute of Psychiatry.

Impact of HIV infection/AIDS on social service agencies serving children and youth in Toronto.

There are few data on how HIV infection/AIDS affects social service agencies serving children and youth. We conducted a survey of 24 provincially funded agencies in the Metro Toronto area and discovered that 36 clients and 9 staff members were HIV-infected. Our data strongly suggest that these agencies were ill equipped to cope with issues surrounding HIV infection/AIDS. Inadequacy or absence of policy and procedures resulted in confusion regarding issues such as HIV testing, need to know, confidentiality, duty to warn, staff and client education, and universal precautions for infection control. In order to effectively deal with the psychosocial, legal, ethical and education needs of clients and staff, agencies must be pro-active in developing policy and procedure.

Persons held on Warrants of the Lieutenant Governor in Canada.

Gross demographic data are supplied on all patients held under Warrants of the Lieutenant Governor in Canada. The composition of the total population varies considerably from one province to another, with resulting differences in such important factors as total time spent on warrant. A plea is made for some kind of continuing monitoring of this expensive-to-treat group, and it is argued that the Boards of Review are, because of lack of basic statistical information, at an unnecessary disadvantage when it comes to making decisions as to whether to release individuals or not. It is suggested that a fairly simple information and tracking system could reduce treatment costs, with concomitant decreases in confinement of patients, without at the same time increasing risk of harm to the general population.