Rationale:

• Sexual assault precipitates a psychological crisis for the patient known as rape trauma syndrome.
• Attention to the initial psychological care of the patient who has been raped is fundamental and can reduce distress during forensic examination.
• Many areas have a local rape crisis agency that can dispatch an advocate to be with patients during the interview and examination.

Evidence:

• Rape trauma syndrome is a pattern of symptoms, similar to PTSD, first termed by researchers after doing a qualitative observational study of patients who had been raped and who presented to Boston City Hospital (59).
• Negative social reactions and victim self blame were associated with worse PTSD symptomology in a longitudinal study of sexual assault surviviors (60).
• Multiple therapies have been effective in attenuating the devastating effects of rape trauma syndrome. A brief cognitive-behavioral program instituted immediately after assault has shown dramatic efficacy in the prevention of chronic PTSD in a prospective observational study of 10 patients compared to a nonrandomized historical control group of 10 patients (61).
• A randomized controlled trial of 168 female patients who experienced sexual assault showed that imagery rehearsal therapy helps reduce chronic nightmares, improve sleep quality, and decrease PTSD symptom severity (62).
• Another randomized controlled trial of 168 sexually assaulted women with PTSD symptoms that studied long-term follow-up over 2 years found that multimodal group therapy improved sleep quality and decreased chronic nightmares and PTSD symptom severity (63).

Comments:

• Psychological support includes appropriate actions to maintain patient comfort during examination. The patient should be interviewed in a private room other than the examination room. An office or a room designated for conversation should be provided by facilities that do forensic sexual assault examinations. The patient should remain in his or her clothes for the interview and then be allowed to disrobe alone in the examination room while the examiner waits outside.