More than 23% of female undergraduates have experienced “sexual assault and sexual misconduct due to physical force, threats of physical force, or incapacitation since they enrolled at their university” according to the 2015 Campus Climate Survey on Sexual Assault and Sexual Misconduct conducted by the American Association of Universities.
Those of us who work as college mental health psychiatrists know firsthand that these sobering statistics are a reality. Sexual assault continues to be an all-too-common problem for university students.
I usually see a sexual assault survivor 3-6 months to a year after the event. She might be experiencing symptoms of depression, anxiety, or posttraumatic stress disorder, and her grades might have declined. She thought that she could handle the event by not talking about it and forgetting about it.
You as a psychiatrist might be the first one she reveals this trauma to. You have an important role in helping her through the journey of recovery.
Your first task should be to establish that she is safe. Does she live near the perpetrator? Does she see him? Is she afraid for her safety?
If the perpetrator is a student, sexual assault survivors usually live in fear of running into him on campus either in class or in housing. A small college, where students might spend all 4 years in campus dorms, poses special challenges for survivors.
The best person who can help the patient establish safety is a victim advocate. Many colleges or local police have a victim advocate, a person a student can talk to without necessarily reporting a crime. This person is an expert at helping students establish boundaries to protect themselves and will work with university officials to make this happen.
In addition to safety, the psychiatrist should address medical issues. Encourage your patient to get a physical exam with testing for sexually transmitted diseases. If the assault is recent, she has the option of getting a forensic exam and can decide later if she will report the assault. Our campus as well as the local emergency room have designated providers who will do a forensic exam.
The decision about pressing charges is a very difficult one for survivors, as rates of prosecution and conviction are low. In fact, few women even report assaults to police or campus officials. According to the Campus Climate Survey, the rate of reporting ranged from 5% to 28%.
I asked Annie Carper, a victim advocate at the University of Florida, Gainesville, about the best way to respond if a patient asks for advice about reporting. She notes that “since control has been taken away from the survivor, you need to give her a range of control to decide what happens next. … Be honest about the process of reporting both at the campus and community level.”
Victim advocates are the best people to provide information about reporting and will work with patients during the process.
Along with addressing safety and medical issues, you will perform a psychiatric evaluation and prescribe medications if needed. Encourage your patient to join a support group for survivors of sexual assault or see an individual therapist. Promote self-care through physical exercise, healthful eating, and avoidance of drugs and alcohol. Assure her that she will feel better with time.
A psychiatrist’s role goes beyond treating survivors of sexual assault. We also should educate our patients, particularly freshmen, with the goal of preventing sexual assault. Freshmen women are the most likely victims of sexual assault, according to the Campus Climate Survey and earlier studies.
Sexual assault can happen to any woman, and it is never her fault. Some helpful, empowering safety tips for female patients follow:
• Take a campus self-defense class.
• Get a good group of friends who will look out for you when you go out.
• Avoid binge drinking and drug use.
• Be aware that 80% of sexual assaults are committed by someone the victim knows, so be cautious as you meet new people on campus and ask trusted friends for feedback.
Many campuses are striving to reduce sexual assault on campus, and I hope there comes a day when this epidemic ends. In the meantime, you as a psychiatrist can help a survivor through the journey of recovery and alter the trajectory of her life for the better.
I would like to acknowledge the helpful feedback and expertise provided by Annie Carper, victim advocate, and Debbie Weiss, a counselor, both at the University of Florida, in writing this article.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
