Secrecy and persistent problems in sexual assault victims.

A substantial number of victims of sexual assault refrain from disclosing to others the victimizing episode and its emotional consequences. A prospective study (n = 36 rape victims reporting theirvictimization to the police) and a retrospective study (n = 33) were conducted to examine the determinants of postponed disclosure and its impact on persistent problems. In the prospective study the time interval between trauma and disclosure was at most one month. In the retrospective study 33 percent postponed disclosure for two years or more. Both studies revealed that postponed disclosure is associated with type of perpetrator: Victims of intimate perpetrators were more inclined to postpone reporting than victims of unknown perpetrators. Postponed disclosure predicted health problems in both studies. In the prospective study postponed disclosure predicted frequency of visits to the doctor and use of medication. Initial feelings of numbness contributed to the use of medication as well. In the retrospective study postponed disclosure predicted psychosomatic complaints and use of medication, even when the time between the assault and the interview was taken into account. Type of perpetrator did not moderate the correlation between postponed disclosure and health problems. Some implications for victim support will be discussed. © 2000, College of Health and Human Sciences. All rights reserved

Narrative Exposure Therapy for Posttraumatic Stress Disorder associated with repeated interpersonal trauma in patients with Severe Mental Illness: a mixed methods design

Background: In the Netherlands, most patients with severe mental illness (SMI) receive flexible assertive community treatment (FACT) provided by multidisciplinary community mental health teams. SMI patients with comorbid posttraumatic stress disorder (PTSD) are sometimes offered evidence-based trauma-focused treatment like eye movement desensitization reprocessing or prolonged exposure. There is a large amount of evidence for the effectiveness of narrative exposure therapy (NET) within various vulnerable patient groups with repeated interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients. Objectives: The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma to get insight into whether (1) PTSD and dissociative symptoms changes and (2) changes occur in the present SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight into patients’ experiences with NET and to identify influencing factors on treatment results. Methods: This study will have a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population will include adult SMI outpatients (n=25) with comorbid PTSD and receiving NET. The quantitative study parameters will be existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, outcomes will be analyzed using mixed models to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters will be experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will be focused on interpreting how qualitative results enhance the understanding of quantitative outcomes. Discussion: The results of this study will provide more insight into influencing factors for clinical changes in this population