Drug-facilitated sexual assault, impaired trauma memory, and implications for mental health treatment.

Background: Sexual assault (SA) is a highly prevalent global public health problem and a robust predictor of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and suicidality. A large percentage are drug or alcohol facilitated (DFSA), impairing trauma memory and affecting the application of evidence-based treatments. Despite these problems, few have investigated DFSA-specific mental health (MH) needs. Objective: Goals of this study were (1) to identify psychological sequelae characterizing DFSA towards explaining why symptoms have been treatment-refractory, comparing survivors with involuntary substance ingestion (forced, covert: DFSA-I), voluntary ingestion (DFSA-V), and non-DFSA; and (2) to determine how impaired trauma memory relates to the development of PTSD and depression symptoms. Method: Data from a retrospective chart review of 74 adults receiving SA MH services at an outpatient trauma center are presented. The sample includes a 2-year cohort seen acutely at an urban rape treatment center. The study is one of the first to examine therapy records beyond case studies for DFSA. Logistic, Poisson, and negative binomial regression analyses of quantitative data and qualitative thematic analysis of trauma cognitions and treatment foci were conducted. Results: DFSA-V had five times greater odds of SUD, and notable substance-related self-blame compared to DFSA-I. DFSA-I had prominent relationship distress and self-blame for missing danger of perpetrator drugging. Survivors with impaired trauma memory had significantly fewer hyper-arousal and overall PTSD symptoms, and specifically less hypervigilance. No differences were found in re-experiencing symptoms. Conclusion: Impaired trauma memory is common in DFSA and is associated with fewer baseline hyper-arousal and overall PTS. Despite this, DFSA issues including re-experiencing symptoms that are particularly distressing without the ability to cognitively connect the intrusions contribute to increased treatment needs. Impaired memory limits the application of evidence-based treatments, and collectively these findings call for the development of trauma-specific treatment protocols to enhance recovery for DFSA survivors. HIGHLIGHTS: Survivors of drug-facilitated sexual assault have prominent PTSD including reexperiencing, though trauma memory may not be encoded. • Those absent trauma memory have less hyperarousal, but DFSA complications explain why it is treatment refractory and inform treatment development.

Antecedentes: La agresión sexual (AS) es un problema de salud pública mundial de alta prevalencia y es un sólido predictor del trastorno de estrés postraumático (TEPT), del trastorno por uso de sustancias (TUS) y de suicidalidad. Un gran porcentaje de AS son facilitadas por drogas o alcohol (ASFDA), deteriorando la memoria del trauma y afectando la aplicación de tratamientos basados en la evidencia. A pesar de estos problemas, pocos han investigado las necesidades de salud mental (SM) específicas de los ASFDA.Objetivo: Los objetivos de este estudio fueron; primero, identificar las secuelas psicológicas que caracterizan a las ASFDA para explicar por qué los síntomas han sido refractarios al tratamiento. Para ello, se comparó a sobrevivientes a una ingestión involuntaria de sustancias (forzada, encubierta: ASFDA-I), a una ingestión voluntaria (ASFDA-V), y a una AS no-ASFDA; y, segundo; determinar cómo el deterioro de la memoria del trauma se relaciona con el desarrollo de síntomas del TEPT y depresión.Método: Se presentan los datos de una revisión retrospectiva de las historias clínicas de 74 adultos que recibieron servicios de SM por AS en un centro de trauma para pacientes ambulatorios. La muestra incluye a una cohorte de 2 años en donde los casos de AS fueron vistos de forma aguda en un centro urbano de tratamiento para violación. El estudio es uno de los primeros, más allá de los estudios de casos, en examinar los registros de terapia por ASFDA. Se realizaron análisis de regresión logística, Poisson y binomial negativa de datos cuantitativos y un análisis temático cualitativo de las cogniciones del trauma y los puntos clave del tratamiento.Resultados: Los ASFDA-V tuvieron cinco veces más probabilidades de TUS y de un notable sentimiento de culpa relacionado con las sustancias comparado con los ASFDA-I. Las ASFDA tenían problemas de relación importantes y sentimientos de culpa por haber pasado por alto el peligro de que el agresor se drogara. Los sobrevivientes con deterioro de la memoria traumática tuvieron significativamente menos síntomas de hiperactivación y del TEPT en general y, específicamente, menos hipervigilancia. No se encontraron diferencias en los síntomas de reexperimentación.Conclusión: El deterioro de la memoria traumática es común en las ASFDA y se asocia con menos hiperactivación de base y síntomas postraumáticos en general. A pesar de esto, los problemas de los ASFDA incluyen a los síntomas de reexperimentación que son particularmente angustiantes y que restan la capacidad de conectar cognitivamente las intrusiones, por lo que contribuyen a aumentar las necesidades de tratamiento. El deterioro de la memoria limita la aplicación de tratamientos basados en la evidencia y, en conjunto, estos hallazgos exigen el desarrollo de protocolos de tratamiento específicos para trauma para mejorar la recuperación de los sobrevivientes a las ASFDA.

Characterizing Drug-Facilitated Sexual Assault Subtypes and Treatment Engagement of Victims at a Hospital-Based Rape Treatment Center.

Variation among existing studies in labeling, defining, identifying, and subtyping cases of suspected drug-facilitated sexual assault (DFSA) poses challenges to integrating research findings for public health purposes. This descriptive study addressed methodological issues of nomenclature and DFSA operational definitions to improve case identification and was designed to distinguish assault subtypes. We studied a 2-year ethnically diverse cohort of 390 patients who presented acutely to an urban rape treatment center (RTC). We abstracted data from RTC medical and mental health records via chart review. Assault incidence rates; engagement into medical, forensic, and mental health services; injury sustained; and weapon use were calculated separately for assault subtypes and compared. DFSA accounted for over half of the total sexual assault (SA) cases. Involuntary DFSA (in which an incapacitating substance was administered to victims without their knowledge or against their will) increased from 25% to 33% of cases over the 2-year period. DFSA victims presented sooner, and more often attended medical follow-up and psychotherapy than non-DFSA victims. Incidence rates indicated increasing risk for young males. These findings indicate that DFSA continues to be a growing and complex phenomenon and suggest that DFSA victims have greater service needs. The field would benefit from innovations to address symptomatology arising from this novel type of trauma and the unique risks and needs of male victims, as well as underscoring the ongoing need for DFSA-specific prevention efforts for both victims and perpetrators.