Understanding rape survivors' decisions not to seek help from formal social systems

Health and Social Work, May, 2009 by Debra Patterson, Megan Greeson, Rebecca Campbell

Rape is a pervasive social problem, as national epidemiological data suggest that at least 17 percent of women will be raped in their adult lifetime (Bachar & Koss, 2001). In addition, rape has been linked to multiple negative short- and long-term outcomes, such as psychological distress, repeated sexual victimization, physical health problems, and difficulties in life functioning (Gutner, Rizvi, Monson, & Resick, 2006; Kilpatrick & Acierno, 2003). To alleviate these negative outcomes, rape survivors may seek help from multiple formal social systems, including the legal, medical, and mental health systems and rape crisis centers. For example, within the legal system, law enforcement may address survivors' immediate safety concerns, inform survivors of their rights, and make referrals to other formal social systems (Campbell, Wasco, Ahrens, Sefl, & Barnes, 2001). Hospital emergency departments may provide information about the risk of pregnancy and sexually transmitted diseases (STDs), prophylaxis to prevent pregnancy and STDs, and forensic evidence collection (Ledray, 1996). Mental health centers offer individual counseling and psychotropic medications. Rape crisis centers may provide medical, police and court advocacy, immediate crisis intervention, individual counseling, and support groups (Campbell, Baker, & Mazurek, 1998).

Despite the variety of services available, few rape survivors use services from these formal social systems. Rates of service utilization vary across studies, but it appears that approximately 14 percent to 43 percent of survivors seek assistance from formal social systems, with most studies finding rates around 31 percent (Campbell et al., 2001; Ullman, 1996; Ullman & Filipas, 2001). When survivors do not receive needed services, their health (for example, STDs) and mental health concerns (for example, posttraumatic stress) may remain untreated, which could cause long-term complications.

To date, studies have suggested four key reasons for these low utilization rates: (1) the survivors' psychological response to the rape, (2) the degree of rape severity (for example, force, injury), (3) fear of retaliation by the assailant, and (4) fear of disbelief by system personnel. First, prior research shows that survivors with lower levels of posttraumatic stress or depressive symptoms are less likely to seek help from formal social systems (Lewis et al., 2005; Starzynski, Ullman, Filipas, & Townsend, 2005). In addition, survivors who blamed themselves for causing the rape were less likely to disclose the rape to formal social systems (Starzynski et al., 2005). Although studies have shown that survivors with less severe psychological symptomatology are less likely to seek assistance, it is still unclear what prevents these survivors from seeking help.

Second, survivors were less likely to seek help from formal social systems when their victimization did not reflect the stereotypical rape (that is, a rape in which the offender is a stranger who uses a weapon or physical force that results in injury). For example, survivors who were raped by a known offender were less likely to seek help than those raped by a stranger (Campbell et al., 2001; Resnick et al., 2000; Starzynski et al., 2005). Furthermore, survivors were more likely to seek assistance if their rape involved the use of physical force or weapons or resulted in physical injuries (Resnick et al., 2000; Starzynski et al., 2005).These findings suggest the severity of the rape plays an important role in survivors' decision making regarding whether to pursue help from formal social systems. However, it is unclear why rape severity affects survivors' decisions in seeking help.

Third, fear of retaliation by the assailant may affect some survivors' decisions to seek help. Bachman (1998) asked survivors to identify their primary reason for not seeking help, and one in 10 reported that they were fearful their assailants would harm them if they sought help. The legal system provides legal remedies (for example, protection orders) to protect survivors from their assailants, but, still, some survivors are not seeking assistance. Given the availability of legal remedies aimed to protect survivors, it is important to understand why fear of retaliation remains an obstacle to seeking help.

Fourth, concerns about how formal social systems personnel may respond to them may prevent some survivors from seeking help. Logan and colleagues (2005) found that survivors did not seek help because they were worried that formal social systems personnel would not believe them. Prior research has shown that survivors experience mistreatment by formal social systems personnel (Campbell & Raja, 2005). Awareness of rape and mistreatment of survivors has become more public in recent years (Caringella-MacDonald, 1998). Thus, it may be possible that survivors may not seek help because they anticipate poor treatment from formal social systems, such as disbelief or other types of mistreatment.