1) Rape victims are at high risk of developing post-traumatic stress disorder (PTSD) with around 31% of victims experiencing it at some point in their lives. They are also more likely to experience depression, have suicidal thoughts, abuse alcohol and drugs. 2) The mental health impacts of rape put a burden on mental health and public health systems in addition to the criminal justice system. 3) Rape victims' most significant concerns are others finding out about the rape, being blamed for it, confidentiality, pregnancy, and contracting STDs. Recent victims are more concerned with pregnancy, STDs and HIV/AIDS. Maintaining privacy is important to address victims' concerns.

1. Case studies
A multiple case study of rape victim advocates' self-care routines: the
influence of organizational context
Date: 2002
Author: Sharon M. Wasco, Rebecca Campbell, Marcia R. Clark
Publication: American Journal of Community Psychology. Volume: 30. Issue: 5
INTRODUCTION
The rape victimology literature has documented many of rape's direct effects on
victims.
Over 30 years of solid empirical evidence suggests that up to one in five American
women will be raped in her lifetime (see Koss, 1993), that after the assault she is
likely to suffer psychological distress (Hanson, 1990; Neville & Heppner, 1999) and
physical health problems (Golding, 1996; Koss & Heslet, 1992), and that she may
employ several types of coping to deal with these experiences (see Burt & Katz,
1988). Additionally, research indicates that although a sizable number of rape victims
are likely to stay silent about their experiences, other victims may turn to family,
friends, or service providers for help and support (George, Winfield, & Blazer, 1992;
Kimmerling & Calhoun, 1994; Ullman, 1996). As victims share their experiences of
sexual assault, the number of individuals exposed to, and impacted by, negative
effects of rape increases exponentially.
A fairly recent trend in the victimology literature explores the vicarious effects of
sexual assault on family members or therapists of rape victims (see McCann &
Pearlman, 1990). Empirical research suggests that those who are in close contact with
rape survivors can experience quite a bit of distress, with female significant others
usually being more affected than males (e.g., Davis, Taylor, & Bench, 1995). Despite
potential negative outcomes, some women do choose careers that involve daily
exposure to rape. The current work explores the assumption that rape crisis work
requires employees to engage in various types of self-care (Stamm, 1995) in order to
perform their job duties effectively and responsibly. Trauma researchers offer the
notion of self-care to distinguish strategies and routines employed by those who work
with trauma victims from more traditional models of coping. A key tenet of self-care
theory is that organizations can be instrumental in facilitating workers' use of such
strategies (see Rosen bloom, Pratt, & Pearlman, 1995). To gain a better understanding
of the strategies women use to deal with a heightened awareness of rape, as well as
the ways organizational context influences such processes, this exploratory study
employed qualitative and quantitative methodologies to describe the subjective
experiences of a small number of rape victim advocates working in diverse settings.
The Ripple Effect of Rape
Empirical studies have shown that secondary traumatization, or secondary traumatic
stress, is prevalent among family members and significant others of violent crime
victims in general (Amick-McMullan, Kilpatrick, & Veronen, 1989; Riggs &
Kilpatrick, 1990), and rape survivors in particular (Barkus, 1997; Davis et al., 1995;
Holmstrom & Burgess,1979; Remer & Ferguson, 1995). "Secondary traumatization"
refers most frequently to indirect effects of trauma, such as experiencing recurring

2. disturbing images, on victims' family members and significant others. Relatedly,
"vicarious traumatization" (McCann &
Pearlman, 1990) and "compassion fatigue" (Figley, 1995) are theories predicting that,
over time, service providers who assist victims may experience indirect psychological
effects of trauma, which can significantly alter the way victim-helpers perceive the
world and have lasting impacts on their feelings, relationships, and lives (McCann &
Pearlman, 1990; Saakvitne & Pearlman, 1996).
Astin (1990) reported that her work with rape victims resulted in nightmares, extreme
tension, and feelings of irritability, lending support to models of indirect
traumatization. Empirical studies have also documented similar experiences among
mental health service providers. Female counselors who work with sexual assault
survivors experience symptoms of distress (e.g., intrusive thoughts or memories,
increased arousal, numbness) similar to those experienced by victims themselves
(Pearlman & MacIan, 1995; Schauben & Frazier, 1995). Trauma counselors also
experience shattering of their basic beliefs about safety, trust in oneself, and trust in
the goodness of others by the traumatic nature of the stories they hear from clients
everyday (Johnson & Hunter, 1997; Pearlman & MacIan, 1995). Victim advocates
who do outreach work with rape survivors seeking help from community systems
report feeling anger and fear in response to helping victims access medical and legal
services (Wasco, 1999; Wasco & Campbell, 2002). This line of research suggests that
as survivors turn to service providers for help, the repeated exposure to the
devastation of rape impacts providers' lives.
Coping With Exposure to Rape
In response to vicarious, secondary, or even direct stress, service providers who work
with rape victims are likely to employ various coping methods. Schauben and Frazier
(1995) were among the first to explore the coping strategies utilized by rape victim
counselors. These researchers surveyed 148 counselors who worked with rape
victims, at least some of the time, about the strategies used to cope with job-related
stresses. Four common types of common strategies emerged from the open-ended
responses. Over 35% of the sample reported engaging in (1) activities that promoted
physical health, (2) spiritually oriented activities, (3) leisure activities, and (4) seeking
both emotional and instrumental support. Other strategies included changing work
conditions, cognitive restructuring, and engaging in political action (Schauben &
Frazier, 1995). In a later study of 73 counselors, Johnson and Hunter (1997) found
that sexual assault counsellors were more likely than other types of counselors to use
escape/avoidance st rategies of coping.
Recently, Iliffe and Steed (2000) interviewed 13 female and 5 male counselors who
worked with domestic violence victims and/or perpetrators. Although participants in
this study were aware of the negative effects that domestic violence counseling had on
their lives (e.g., burnout, changes in views about the world), they were able to utilize a
wide range of strategies to deal with these issues. Debriefing and peer support were
identified by all the participants in this study as the most important resources for
dealing with the difficult nature of their work (Iliffe & Steed, 2000). Also, socializing
and physical activity, such as exercise or gardening, reading, and participating in
recreational activities, were commonly cited as strategies to reduce negative effects of
counselling sessions. Counselors also reported thinking about positive things, such as

3. identifying clients' resilience and strength, and discussed channeling their anger,
feelings of xpowerlessness, and other energy into sociopolitical activism as helpful
coping strategies (Iliffe & Steed, 2000).
Case Study 2
The Mental Health Impact of Rape
Dean G. Kilpatrick, Ph.D.
National Violence Against Women Prevention Research Center
Medical University of South Carolina
The National Women's Study produced dramatic confirmation of the mental health
impact of rape. The study determined comparative rates of several mental health
problems among rape victims and non-victims. The study ascertained whether rape
victims were more likely than non-victims to experience these devastating mental
health problems. Posttraumatic Stress Disorder.
The first mental health problem examined was posttraumatic stress disorder (PTSD),
an extremely debilitating disorder occurring after a highly disturbing traumatic event,
such as military combat or violent crime.
Almost one-third (31%) of all rape victims
developed PTSD sometime during their
lifetime; and more than one in ten rape victims
(11%) still has PTSD today.
Rape victims were 6.2 times more likely to
develop PTSD than women who had never
been victims of crime (31% vs 5%).
Rape victims were 5.5 times more likely to
have current PTSD than those who had never
been victims of crime (11% Vs 2%).
The U.S. Census Bureau estimates that there
are approximately 96.3 million adult women in
the United States age 18 or older. If 13% of
American women have been raped and 31% of
rape victims have developed PTSD, then 3.8
million adult American women have had rape-
related PTSD (RR-PTSD):
If 11% of all rape victims have PTSD, then an estimated 1.3 million
American women have RR-PTSD.
I f 683,000 women are raped each year, approximately 211,000 will
develop RR-PTSD annually
Other Mental Health Problems
Major depression is a problem affecting many women, not just rape victims.

4. However, 30% of rape victims had experienced at least one major depressive episode
in their lifetimes, and 21% of all rape victims were experiencing a major depressive
episode at the time of assessment:
By contrast, only 10% of women
never victimized by violent crime had
ever had a major depressive episode;
and only 6% had a major depressive
episode when assessed.
Rape victims were three times more
likely than non-victims of crime to
have ever had a major depressive
episode (30% Vs 10%). Also, they
were 3.5 times more likely to be
currently experiencing a major
depressive episode (21% Vs 6%).
Some mental heath problems are life
threatening. When asked if they ever thought
seriously about committing suicide:
One-third (33%) of the rape victims
and 8% of the non-victims of crime said yes.
Rape victims were 4.1 times more likely than non-crime victims to have
contemplated suicide.
Rape victims were 13 times more likely than non-crime victims to have
attempted suicide (13% Vs 1%).
Substance Abuse
There was substantial evidence that rape victims had higher rates than non-victims of
drug and alcohol consumption and a greater likelihood of having drug and alcohol-
related problems. Compared to women who had never been crime victims, rape
victims with RR-PTSD were:
13.4 times more likely to have two or more major alcohol problems (20.1%
Vs 1.5%).
26 times more likely to have two or more major serious drug abuse
problems (7.8% Vs 0.3%).
The National Women's Study findings provide
compelling evidence about the extent to which
rape poses a danger to American women's
mental health -- and even their continued
survival -- because of increased suicide risk.
Thus, rape is a problem for America's mental
and public health systems as well as the
criminal justice system.
Key Concerns of Rape Victims
To effectively respond to rape victims, service
providers and criminal justice officials need to
understand the major concerns of rape victims.
Without accurate information, it is difficult to

5. develop policies and programs to meet victims’ needs.
The National Women’s Study identified several critical concerns. To determine
whether victims’ concerns have changed over time, the study divided these concerns
into two categories: all rape victims vs. victims that had been raped within the
previous five years (1987-91). The changes in concerns included:
The victim’s relatives knowing about the assault: Relatively little change over
time. Seventy-one percent of all victims and 66% of victims within past five
years are concerned about relatives finding out about the rape.
People blaming the victim: Rape victims are concerned about being blamed
for the rape, and this has not changed over time. In fact, 69% of all victims
and 66% of recent rape victims say they worry about being blamed.
People outside her family knowing she had been sexually assaulted: No
significant difference. Sixty-eight percent of all victims and 61% of rape
victims within the past five years are concerned about this.
The victim’s identity being revealed in the news media: Women raped within
the last five years are more likely to be concerned about the possibility of their
names being published than all rape victims (60% vs. 50%).
Becoming pregnant: Sixty-one percent of recent rape victims, as opposed to
34% of all rape victims, are concerned about getting pregnant.
Contracting a sexually transmitted disease (not including HIV/AIDS): Recent
rape victims were more than twice as concerned as all rape victims about
contracting sexually transmitted diseases. (43% Vs 19%).
Contracting HIV/AIDS: Recent rape victims were four times more likely than
all victims to be concerned about getting HIV/AIDS as a result of the rape -
regardless of the recency of the rape (40% Vs 10%).
The stigma of rape persists. Victims are greatly concerned about others
discovering they were raped. Service providers and criminal justice officials
should endeavor to maintain the confidentiality and respect the privacy needs
of victims
From this case study I have gathered that post dramatic stress disorder is a high risk
for the mental state of those suffered from a rape attack.