Russell, Emma; (2001) The psychological consequences of drug rape. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

'Drug-rape', an increasingly prevalent crime (Sturman, 2001), occurs when a centrally acting drug is administered to a victim to facilitate a sexual assault or rape. The effects of the drugs used include muscle relaxation, disinhibition and anterograde amnesia. Experimental and clinical research has demonstrated that these drugs impair conceptual processing and explicit memory, whilst sparing data-driven processing and implicit memory (Bishop and Curran, 1995; Curran, 2000). These drug effects share similarities with dissociation, a known predictor of PTSD (Mechanic et al, 1998). The present study is the first to systematically explore the psychological consequences of drug-rape and associated memory loss. A retrospective self-report design was employed, using both questionnaires (N = 29) and interviews (N = 12). Participants were female drug-rape survivors (over 18 years old) who were recruited through rape support organisations. Informed by current cognitive conceptualisations of posttraumatic stress disorder (PTSD), memory and cognitive psychopharmacology (e.g. Brewin et al, 1996; Ehlers and Clark, 2000; Curran. 2000), it was hypothesised that a number of factors would predict the prevalence and severity of PTSD. This was selected as the primary outcome variable as prospective research demonstrates that most rape survivors develop PTSD (Rothbaum et al, 1992). Eighty percent of participants reported moderate to severe PTSD, with clinical levels of anxiety and depression being reported by 90[percent] and 69[percent] respectively. Participants reported persistent and extensive anterograde amnesia of the rape. However, even with extensive impairment of explicit memory, all reported distressing, involuntary intrusive memories characterised by a strong sense of 'reliving' the rape. The prevalence and severity of PTSD was not significantly associated with loss of consciousness during the rape, or extent of perceived amnesia, and was comparable with other trauma populations. Ratings of peritraumatic dissociation significantly predicted PTSD symptomatology, as found in previous research (e.g. Griffin et al, 1997). A diagnosis of PTSD requires that individuals experience intense fear, helplessness or horror during trauma (criterion A2: DSM-IV, APA, 1994), and experience actual or perceived threat to physical integrity (criterion A1). Participants reported high levels mental confusion and helplessness, but very low levels of fear during the assault, and sixty-five percent of participants reported no perceived life threat. This indicates that the drugs have significant anxiolytic effects even during rape. Consequently, over a third of participants did not meet criterion A1 or A2. Importantly, these participants reported re-experiencing arousal and avoidance PTSD symptoms of comparable severity to those who met criterion A. In fact, reduced fear during rape was associated with higher negative appraisals, fear and PTSD post-assault. The results of this study suggest that the drugs impair cognitive and emotional processing during sexual assault. These impairments, which show similarities to dissociation, elicit more extensive negative appraisals post-assault, and have repercussions for subsequent emotional processing. Furthermore, the results demonstrate that significant posttraumatic symptomatology is not precluded by a reduced emotional response during rape, or by persistent and severe impairment of explicit memory. The findings of this research are further considered in relation to both clinical implications and current theoretical conceptualisations of PTSD.

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