Abstract
Little research has examined the relationship between women’s labeling of their sexual assault experiences and sexual functioning, as well as identification of variables that may mediate the labeling-trauma outcome relationship. The purpose of this study was to fill this gap in the literature, by examining the potential mediating role of coping strategies in response to sexual assault in the relationship between labeling and sexual functioning. The sample included 135 college women with a history of adolescent/early adulthood sexual assault. Labeling was not bivariately related to sexual functioning outcomes; however, anxious coping mediated the relationships between labeling and both sexual lubrication and sexual satisfaction. This suggests that correlational analyses between labeling and trauma outcomes may not capture the complexity of this relationship, as it may be more indirect. Furthermore, results suggest that labeling is part of the coping process in response to sexual assault; some women who consider their experience to be sexual assault may engage in anxious coping efforts, contributing to difficulties with sexual lubrication and sexual dissatisfaction. Victims actively working to integrate their sexual assault experience with prior beliefs and self-concept may benefit from treatment focused on decreasing anxious coping, especially as it relates to sexual functioning.
Sexual victimization remains a pervasive problem among college women; approximately 20% of college women will experience sexual victimization over just a 7-month period (Orchowski & Gidycz, 2012). Experiences of sexual assault are associated with a number of short- and long-term negative psychological (e.g., Campbell, Dworkin, & Cabral, 2009) and sexual health outcomes including sexual difficulties and dysfunctions (e.g., Weaver, 2009). Although many women experience an incident that meets the legal definition of sexual assault, many women do not label their experience as such; these women are typically described as unacknowledged victims. Research shows that the majority of rape victims are unacknowledged (e.g., Bondurant, 2001). Whether labeling of sexual assault experiences is associated with sexual health outcomes and the recovery process remains an important question with equivocal answers. The purpose of this study is twofold: (a) to explore the relationship between labeling of adolescent/early adulthood sexual assault (ASA) and sexual functioning domains and (b) to examine whether specific coping strategies mediate the relationship between labeling of sexual assault and sexual functioning domains in a sample of college women with a history of ASA.
The emotional processing theory of posttraumatic stress disorder (PTSD; Foa, Steketee, & Rothbaum, 1989) and the information-processing model of interpersonal violence (e.g., Resick & Schnicke, 1992) indicate that meaning-making is an important part of trauma recovery, such that victims of sexual assault must integrate information about their traumatic event with their belief system, which can lead to discrepancies that victims must resolve through changes either in their belief system or in their interpretation of the traumatic incident. The outcome of such integration is related to trauma victims’ response and recovery (e.g., Resick & Schnicke, 1992; Surís, Link-Malcolm, Chard, Ahn, & North, 2013), and implicates that a sexual assault victim’s conceptualization of her experience (e.g., labeling) is an important variable in recovery (Littleton, 2007) and may subsequently be related to the use of coping strategies and health outcomes (e.g., Holguin & Hansen, 2003).
Labeling and its effects have been extensively researched for several decades, and such research and theory have pointed to both positive and negative outcomes of labeling that may affect the recovery process. Some research and theory highlights potentially negative aspects of the act of self-labeling. For example, labeling theory (e.g., Scheff, 1966) related to mental illness highlights the possible stigmatizing effects of labeling and the potential for the establishment of a set of negative perceptions that lead to dysfunctional behaviors and a self-fulfilling prophecy (Holguin & Hansen, 2003). However, other work indicates that the act of self-labeling can facilitate help-seeking and service utilization (e.g., Wright, Jorm, Harris, & McGorry, 2007), which may ultimately contribute to successful recovery. Consequently, understanding how labeling of sexual victimization relates to functioning may have important implications for theory and research and clinical work related to sexual assault recovery.
Therefore, recent research has been conducted with aims to understand whether labeling of sexual assault is indeed associated with outcomes and the recovery process. It has been proposed that labeling an experience as sexual assault or rape would be beneficial to recovery, such that women need to “redefine” what happened to them to recover from the experience (e.g., Gidycz & Koss, 1991); such acknowledgment can lead to increased rates of reporting sexual victimization and increased help-seeking and service utilization (Harned, 2005; Zinzow, Resnick, Carr, Danielson, & Kilpatrick, 2012). From this perspective, women who are able to successfully integrate their experience of ASA with their prior beliefs may be more likely to label their experience as sexual assault, leading to more adaptive response and recovery. Previous research has examined this hypothesis through exploration of the relationship between labeling and psychological outcomes. However, findings are varied; for example, some research documents that labeling is associated with greater posttraumatic stress disorder symptoms (e.g., Layman, Gidycz, & Lynn, 1996) whereas other research finds few differences between labelers and nonlabelers on psychological outcomes (e.g., McMullin & White, 2006). However, little research has explored how labeling may relate to domains of sexual functioning (e.g., inhibited sexual arousal, sexual pain) despite ample evidence to suggest that sexual victimization is associated with negative sexual health outcomes (e.g., Leonard, Iverson, & Follette, 2008; Weaver, 2009) and has a relatively stronger negative impact on sexual health as compared to other forms of trauma (e.g., Lemieux & Byers, 2008; Schloredt & Heiman, 2003).
Indeed, ASA is associated with a number of negative sexual health outcomes including increased rates of sexual difficulties and sexual dysfunctions such as fear of sex and inhibited arousal and desire, and orgasm difficulties (see Weaver, 2009, for a review). However, in the only study to date to examine the specific relationship between labeling and sexual functioning, Layman et al. (1996) examined this relationship in a sample of 85 college women with a history of rape since the age of 14. In response to a multiple choice question asking how women would describe the situation, women who endorsed “I don’t feel I was victimized,” “I believe I was a victim of serious miscommunication,” or “I believe I was a victim of a crime other than rape” were considered unacknowledged victims, whereas women who endorsed “I believe I was a victim of rape” were considered acknowledged victims. Results showed no differences between acknowledged and unacknowledged victims on sexual experience, drive, or satisfaction assessed by the Derogatis Sexual Functioning Inventory (Derogatis & Melisaratos, 1979). Additional research examining a broader spectrum of sexual functioning domains may be beneficial given the vast array of sexual difficulties documented among sexual assault victims. Based on contentions that labeling is beneficial to recovery (e.g., Gidycz & Koss, 1991; Wright et al., 2007), it is expected that women who label their ASA experience as sexual assault would experience fewer sexual functioning difficulties whereas non-labeling women would experience more difficulties with sexual functioning.
Furthermore, the relatively mixed results found on the relationship between labeling and psychological outcomes, in addition to the null findings on the relationship between labeling and sexual functioning from Layman and colleagues (1996), suggest that the relationship between labeling of ASA and outcomes is likely mediated by other variables associated with recovery. One such variable that might mediate the relationship between labeling of sexual assault and sexual functioning is coping in response to ASA.
Coping strategies are typically used in response to a trauma and are related to the recovery process following sexual victimization, subsequently influencing health outcomes such as sexual and psychological functioning (e.g., Frazier & Burnett, 1994; Littleton, Breitkopf, & Berenson, 2007). Different conceptualizations of coping strategies have been utilized across studies and theories (e.g., differentiating between problem-focused and emotion-focused coping, versus between approach and avoidance coping). Yet in general, there has been some evidence that certain coping strategies are considered to be more adaptive (e.g., positive thinking, seeking social support) and are related to improved post-assault functioning whereas other strategies are conceptualized as maladaptive (e.g., withdrawal, alcohol use) and are typically associated with impaired post-assault functioning (e.g., Frazier & Burnett, 1994; Frazier, Mortensen, & Steward, 2005). Furthermore, in a modified version of labeling theory, Link and colleagues (Link, Struening, Cullen, Shrout, & Dohrenwend, 1989) propose that coping strategies are an important mediator in the relationship between labeling and symptomatology. Given this information, it is possible that the types of coping strategies used by the victim mediate the relationship between labeling of sexual assault and sexual functioning outcomes. In a sample of college women with a history of rape, Littleton (2007) found that women who engaged in the lowest levels of both approach and avoidance coping were less likely to label their experience as a victimization than both women who engaged in moderate levels of approach and avoidance coping and women who engaged in high levels of avoidance coping and low levels of approach coping. Overall, these results provide some evidence that labeling of rape experiences is related to coping strategies used. Further following the proposal that labeling of sexual assault is beneficial to recovery, it might be expected that labeling would be associated with more adaptive forms of coping (e.g., seeking social support, adaptive cognitions) whereas not labeling an incident would be associated with more maladaptive forms of coping (e.g., cognitive and behavioral avoidance) strategies.
The purpose of this study was to examine the relationship between women’s labeling of their ASA experiences and sexual functioning domains, and to examine whether the relationships between labeling and domains of sexual functioning (i.e., sexual arousal, desire, lubrication, orgasm, satisfaction, and pain) are mediated by the use of specific coping strategies (i.e., avoidance, expressive, anxious/nervous, cognitive, and self-destructive) among a sample of college women with a history of ASA. Consideration of these relationships among specific domains of sexual functioning, rather than an overall measure of sexual functioning, may better inform treatment efforts. Indeed, research indicates that specific sexual domains are considered independent and may have different predictors and correlates (Leonard et al., 2008; Rosen et al., 2000; Suvak, Brogan, & Shipherd, 2012). The following hypotheses were proposed:
More specifically, the use of maladaptive coping strategies (avoidance, anxious, self-destructive) would mediate the relationship between labeling and sexual functioning, such that women who consider their experience to be sexual assault to a lesser (or no) extent would engage in greater maladaptive coping that in turn would be related to increased sexual functioning difficulties. Further, the use of adaptive coping (i.e., cognitive, expressive) would mediate the relationship between labeling and sexual functioning such that women who consider their experience to be sexual assault to a greater extent would engage in greater adaptive coping that in turn would relate to fewer sexual functioning difficulties.
Method
Participants
Participants in this sample consisted of 194 college women who reported a history of ASA; these women participated in a larger study examining the cognitive, affective, and behavioral variables relating to sexual health associated with sexual victimization (Kelley & Gidycz, 2014). Only women who reported being sexually active (not exclusive to sexual activity within dating relationships) were retained for analyses. Thus, 55 women were excluded from analyses given that they reported no engagement in sexual activity; an additional 4 women were dropped from analyses because they reported that their ASA experience occurred in the past 4 weeks (to reduce overlap with the sexual functioning measure). Therefore, a total of 135 women were considered in the remaining analyses. The average age of participants was 19.16 (SD = 1.48, range = 18 to 23), and most participants (60.0%) were in their first year of college. The majority of participants (85.9%) self-identified as Caucasian, followed by multi-racial (4.5%), Asian/Pacific Islander (4.4%), African American (3.7%), and Latino/Hispanic (1.5%). Most (81.5%) of the sample reported exclusively heterosexual experiences. With regard to family income, 66.7% reported an annual income of US$51,000 or greater.
Measures
Adolescent/adult sexual victimization
The Sexual Experiences Survey–Short Form Victimization (SES-SFV; Koss et al., 2007) is a behaviorally specific measure of experiences of ASA ranging from unwanted fondling or sexual contact to forcible rape that have occurred on or after the 14th birthday. Each participant was categorized into one of five categories of ASA, increasing in severity: (a) no sexual victimization history, (b) unwanted sexual contact, (c) sexual coercion, (d) attempted rape, or (e) completed rape. Only women endorsing victimization including the last three categories (i.e., sexual coercion, attempted rape, completed rape) were retained for the present analyses. Given that severity of sexual victimization is associated with post-assault trauma (Briere & Runtz, 1990), women who experienced unwanted sexual contact only were excluded, as these women may report post-assault outcomes more similar to women who have not reported any unwanted sexual experiences, and to ensure the homogeneity of the victimization groups for analyses. Predictive validity for the SES-SFV has been demonstrated, such that ASA history as defined by the SES-SFV was predictive of trauma symptomatology over a 1-week follow-up (Murphy, Gidycz, & Johnson, 2013).
Adolescent/adult sexual victimization characteristics
Women who endorsed an item on the SES-SFV were asked to respond to the item “to what degree do you describe the incident as sexual assault?” on a five-point scale ranging from 1 (not at all sexual assault) to 5 (definitely sexual assault), representing their degree of labeling of their experience as sexual assault. If a woman endorsed more than one incident, she was asked to respond in reference to the most distressing of these experiences.
Sexual functioning
The Female Sexual Function Index (FSFI; Rosen et al., 2000) is a 19-item measure administered to assess six domains of female sexual functioning: desire, arousal, lubrication, orgasm, satisfaction, and pain that refer to the participants’ experience in the past 4 weeks. Participants respond to each item on a 5-point scale, with specific responses varying somewhat for each domain to reflect frequency, level of difficulty, level of satisfaction, and/or confidence in each domain (see Rosen et al., 2000, for additional scoring information). Scores for each domain are derived by multiplying the subscale item sums by a factor weight with higher scores reflecting greater difficulty with that domain of sexual functioning. Cronbach’s alphas for the current sample were as follows: desire (.80), arousal (.91), lubrication (.92), orgasm (.94), satisfaction (.87), and pain (.92). Good construct validity was demonstrated by significant mean difference scores on the FSFI between women diagnosed with female sexual arousal disorder and age-matched control groups for each of the six domains (Rosen et al., 2000).
Coping strategies
A modified version of the “How I Deal With Things” Scale (HIDWT; Burt & Katz, 1987) assessed for participants’ use of several different coping strategies in response to their ASA experience (endorsed on the SES-SFV) and consists of five subscales: Avoidance, Expressive, Anxious/Nervous, Cognitive, and Self-Destructive. Participants were asked to respond to each item in reference to how often they used the described strategy in coping with their ASA experience. All items are on a 7-point rating scale ranging from 0 (never/not at all) to 6 (all the time/very much). Only 29 of the original 33 items are included in the current study as four of the original items were excluded because they did not load on any of the factors in the factor analysis conducted by Burt and Katz (1987). Subscale scores for each participant were computed by summing the scores, with higher scores indicating greater use of that form of coping. Cronbach’s alphas for this sample were as follows: Avoidance (.83), Expressive (.84), Anxious/Nervous (.81), Cognitive (.81), and Self-Destructive (.71). Construct validity for the subscales were also demonstrated through moderate correlations between the subscale scores and measures of symptomatology (Burt & Katz, 1987).
Procedure
Following Institutional Review Board approval, participants were recruited from introductory psychology courses. Participation contributed to course grading although students were provided alternative options to participation in research studies (i.e., reading and summarizing empirical articles). Women who participated completed paper-and-pencil surveys in group testing environments administered by the first author, after completing informed consent. Following survey completion, participants received debriefing and referral information.
Results
Descriptive Statistics
Of the 135 women with a history of sexual assault, 27.3% (n = 54) reported experiencing sexual coercion, 21.7% (n = 43) experienced attempted rape, and 51.0% (n = 101) experienced completed rape. Means and standard deviations of the study variables are presented in Table 1.
Means, Standard Deviations, and Bivariate Correlations of Study Variables for Full Sample (N = 135).
Note. Given that rape severity is coded as ordinal, the mean and standard deviation are not reported.
p < .05. **p < .01. ***p < .001.
Contrary to the hypothesis, degree of labeling the ASA experience as sexual assault was not significantly correlated with any domain of sexual functioning (i.e., sexual desire, arousal, lubrication, orgasm, satisfaction, and pain). See Table 1 for correlation statistics.
Although the bivariate relationships between labeling and sexual functioning were nonsignificant, additional analyses were conducted to explore whether labeling was more indirectly related to sexual functioning, such that the labeling–sexual functioning relationship is mediated through the use of coping strategies. Tests of mediation require that the independent variable (i.e., labeling) is associated with the mediator(s) (i.e., coping strategy(s)) and that the mediator(s) is significantly related to the dependent variable (i.e., sexual functioning domain; Baron & Kenny, 1986). More contemporary views of mediation analyses do not require that there is a significant total effect of the independent variable on the dependent variable (e.g., MacKinnon, Krull, & Lockwood, 2000). Thus, according to the results of the significant correlation analyses presented in Table 1, four mediational tests were conducted to answer the following questions: (a) Does the use of anxious coping and cognitive coping mediate the relationship between labeling and sexual lubrication difficulties? (b) Does the use of avoidance coping mediate the relationship between labeling and orgasm difficulties? (c) Does the use of anxious coping mediate the relationship between labeling and sexual satisfaction? and (d) Does the use of anxious coping and avoidance coping mediate the relationship between labeling and sexual pain?
The extent to which coping strategies mediate the relationship between labeling and sexual functioning difficulties was assessed by employment of the PROCESS SPSS macro developed by Hayes (2013). This macro allows for examination of the indirect effect (i.e., the indirect effect of labeling on sexual functioning via coping) using bias-corrected and accelerated bootstrapped confidence intervals of the indirect effects. Use of the bootstrapping method to explore indirect effects is documented to be more powerful and makes fewer unrealistic assumptions (e.g., regarding the shape of the sampling distribution of the indirect effect) than other inferential methods such as the Sobel test (MacKinnon, Lockwood, & Williams, 2004). Thus, bootstrapping to test mediation can be beneficial for smaller samples and is considered appropriate for samples larger than 20 (Polansky, 1999). The number of bootstrap samples utilized for each analysis was 5,000 (similar results were obtained when the number of bootstrap samples was set to 1,000, suggesting convergence). In addition, this macro allows for the consideration of covariates in mediational models. Given that severity of sexual assault was associated with degree of labeling in the present study, severity level of sexual assault was entered into each mediation analysis as a covariate to better understand whether labeling plays a unique role in the mediation analyses, above and beyond severity of assault.
Regarding the mediation model examining sexual lubrication difficulties, labeling was positively associated with anxious coping (B = 2.06, SE = 0.57, p < .001) as well as cognitive coping (B = 2.53, SE = 0.57, p < .001). In turn, anxious coping was positively associated with lubrication difficulties (B = 0.03, SE = 0.01, p < .05); however, cognitive coping was unrelated to lubrication difficulties (B = 0.01, SE = 0.01, p = .699). Severity of sexual assault was not associated with anxious coping (B = 0.21, SE = 1.38, p = .880), cognitive coping (B = 0.36, SE = 1.39, p = .798), or lubrication difficulties (B = 0.09, SE = 0.13, p = .454). Concerning the total indirect effect considering both anxious and cognitive coping as mediators of the labeling–lubrication difficulties relationship, this effect was statistically significant (B = 0.06, SE = 0.03, 95% CI [0.03, 0.12]). However, when considering the specific indirect effects of each coping strategy in this model, only the specific indirect effect of anxious coping was significant (B = 0.05, SE = 0.02, 95% CI [0.02, 0.11]), whereas the specific indirect effect of cognitive coping was nonsignificant (B = 0.01, SE = 0.03, 95% CI [−0.03, 0.05]).
Regarding the mediation model for orgasm difficulties, labeling was significantly positively associated with avoidance coping (B = 2.51, SE = 0.64, p < .001); however, avoidance coping was unrelated to orgasm difficulties (B = 0.03, SE = 0.01, p = .062). In addition, severity of sexual assault was unrelated to avoidance coping (B = 0.22, SE = 1.57, p = .888) as well as orgasm difficulties (B = 0.13, SE = 0.24, p = .592). Similarly, the indirect effect of labeling on orgasm difficulties via avoidance coping was nonsignificant (B = 0.06, SE = 0.04, 95% CI [−0.06, 0.17]).
Regarding the model examining sexual satisfaction, labeling was positively related to anxious coping (B = 2.01, SE = 0.56, p < .001), and in turn, anxious coping was associated with greater sexual dissatisfaction (B = 0.03, SE = 0.01, p < .05). Severity of sexual assault was unrelated to anxious coping (B = 0.10, SE = 1.37, p = .941) as well as sexual satisfaction (B = 0.12, SE = 0.19, p = .518). Furthermore, the indirect effect of labeling on sexual dissatisfaction via anxious coping was statistically significant (B = 0.05, SE = 0.03, 95% CI [0.01, 0.13]).
Examination of the model regarding sexual pain revealed that labeling was positively associated with avoidance coping (B = 2.51, SE = 0.64, p < .001) as well as with anxious coping (B = 2.01, SE = 0.56, p < .001). However, both avoidance coping and anxious coping were unrelated to sexual pain (B = 0.01, SE = 0.01, p = .547; B = 0.02, SE = 0.01, p = .192, respectively). Severity of sexual assault was unrelated to avoidance coping (B = 0.22, SE = 1.56, p = .888), anxious coping (B = 0.10, SE = 1.37, p = .941), and sexual pain (B = 0.14, SE = 0.16, p = .377). Whereas the total indirect effect of labeling on sexual pain via avoidance and anxious coping was statistically significant (B = 0.06, SE = 0.03, 95% CI [0.02, 0.12]), the specific indirect effects of avoidance and anxious coping were each individually nonsignificant (B = 0.02, SE = 0.04, 95% CI [−0.04, 0.08]) and (B = 0.04, SE = 0.04, 95% CI [−0.01, 0.12]), respectively.
Discussion
The purpose of this study was to better understand the relationship between labeling of ASA experiences and sexual functioning domains and to examine whether coping strategies used in response to ASA mediate this relationship among college women. Results indicated that there was no significant bivariate association between degree of labeling an ASA experience as sexual assault and sexual functioning in any of the assessed domains. These results are consistent with the only previous study to date that has explored the relationship between labeling and sexual functioning (Layman et al., 1996) and indicate that there is no evidence of a direct relationship between labeling and sexual functioning. However, additional correlation analyses demonstrated that a greater degree of victim’s labeling her experience as sexual assault was associated with greater use of most types of coping strategies, such that labeling was associated with greater use of both adaptive (i.e., cognitive, expressive) and maladaptive (i.e., avoidant, expressive) coping strategies. These results may suggest that women who consider their experience as sexual assault to a greater extent may be actively trying to integrate their experience with prior beliefs and their self-concept, and subsequently engage in greater coping efforts. Perhaps if women perceive themselves as sexual assault victims, they engage in coping efforts of several types to deal with the traumatic experience, consistent with the conceptualization that labeling and coping strategies in response to sexual assault are integral to the trauma recovery process.
The current researchers sought to explore whether coping strategies used in response to sexual assault mediate the relationship between labeling and sexual functioning. Results provided some evidence that labeling of ASA is indirectly related to sexual functioning domains, through the use of specific forms of coping strategies. This indirect relationship between labeling and symptomatology, via coping, is consistent with Link and colleagues’ (1989) modified labeling theory. In the current study, the nature of this mediated relationship differed depending on the type of sexual functioning domains, and identified maladaptive coping strategies as most salient.
More specifically, results showed that women who labeled their experience as sexual victimization to a greater extent engaged in greater anxious coping, which in turn was associated with greater experience of sexual lubrication difficulties. Similar results were found for sexual satisfaction, such that a greater degree of labeling was associated with increased use of anxious coping, which in turn was associated with greater sexual dissatisfaction. Mediational analyses conducted for the domains of orgasm and sexual pain were each nonsignificant, suggesting that labeling is not indirectly related to these sexual functioning difficulties through coping. In addition, preliminary correlation analyses did not provide evidence for such a mediational relationship for either sexual desire or sexual arousal, both of which are considered to be the initial stages of the sexual response cycle. Perhaps the anxiety inherent in anxious coping strategies disrupts specific parts of performance (i.e., lubrication) during sexual activity whereas other stages remain unrelated to or unaffected by anxious coping. Such a conceptualization appears consistent with research and theory documenting that domains of sexual functioning are at least partially independent and have unique predictors and correlates (e.g., Rosen et al., 2000).
In general, these results were somewhat contradictory to the hypotheses based on the proposal that labeling would be beneficial to sexual assault victims’ recovery. However, the current results suggest that women who label their experience as sexual assault and engage in anxious coping strategies (e.g., experiencing difficulty with anxious emotions that can have a negative impact on with interpersonal functioning and physiological response) experience inhibited sexual satisfaction and difficulties with sexual lubrication. Given that anxious coping appears reflective of anxiety, which typically involves physiological response variables, the physiological aspect of sexual experiences (i.e., lubrication) could become inhibited. If labeling represents the integration of the experience of sexual assault with prior beliefs and self-concept, this integration may have particular consequences for the sexual self-concept as it relates to sexual satisfaction. Perhaps these women are experiencing difficulty with the integration of the sexual assault experience with their more recent general sexual experience, contributing to sexual dissatisfaction. Or alternatively, it may be that sexual lubrication difficulties lead or contribute to lowered sexual satisfaction. Perhaps these results are more consistent with contentions that labeling may be associated with more maladaptive sets of perceptions and expectations that contribute to symptomatology (Holguin & Hansen, 2003).
Also, consistent with Littleton’s (2007) findings were results suggesting that low levels of labeling were not necessarily associated with maladaptive responses (i.e., increased sexual functioning difficulties), which was somewhat contradictory to hypotheses. As noted by Littleton (2007), however, there may be important long-term risks or negative outcomes for non-labeling such that a lack of labeling an experience as sexual assault could lead to revictimization in the future (such that victims may have difficulty recognizing their experience as victimization, subsequently leading to little or no changes in sexual assault−risk response behaviors). For example, previous studies have shown that non-labeling is associated with continuing a relationship with the perpetrator (e.g., Layman et al., 1996). Thus, it is important to note that the current study was cross-sectional and assessed for labeling of sexual victimization, coping, and sexual victimization concurrently. However, coping is typically considered a process (Gutner, Rizvi, Monson, & Resick, 2006), and similarly, labeling may in fact best be conceptualized as a process that occurs over time. Thus, the stage that a woman is in during her labeling and integration process may be an important variable to examine more thoroughly in future studies examining the link between labeling, coping, and sexual health outcomes. For example, women who are early in the stages of labeling or understanding their sexual assault may be having difficulty making sense of their victimization experience although they recognize it as victimization and experience anxious coping (e.g., “I cannot trust anyone in a sexual encounter”). Conversely, women who are further along in their conceptualization or labeling process may have already successfully integrated their experience and thus are unengaged in coping efforts or are engaged in more positive coping efforts, and subsequently experience a lack of sexual functioning difficulties. Indeed, future research should utilize longitudinal designs to examine relationships between labeling, coping, and sexual functioning over time.
Finally, the results of the current study might also provide evidence that maladaptive coping is more strongly related to negative outcomes whereas more positive coping does not necessarily relate to positive recovery outcomes. These findings are consistent with other research showing that in some cases, negative or maladaptive variables are more harmful to recovery whereas factors that are expected to be positive or buffering factors may not have the expected significant positive effects on trauma recovery. For example, research examining support providers’ reactions to victims’ disclosure of their sexual assault experience shows that negative social reactions to disclosure have strong negative impacts on post-assault recovery whereas positive social reactions are inconsistently related to post-assault recovery (Ullman, 1999). Thus, women who are actively trying to conceptualize their ASA experience and integrate it into their belief system and sense of self-concept may benefit from treatment that focuses on reducing their use of anxious coping.
Although the results of the current study provide some evidence that anxious coping mediates the relationship between labeling of ASA and the experience of sexual lubrication and satisfaction difficulties, it is not without limitations. The current study assessed for the variables of interest with retrospective self-report surveys assessed at one time-point. This design limits the ability to determine temporal relationships among variables, such as whether labeling status changes over time, and whether the relationships between labeling, coping, and sexual functioning are dynamic and fluctuate over time. Furthermore, results of this study may be limited by low power; considering the small to medium size of the direct effects further explored in the mediation analyses, additional research should seek to replicate these findings with a larger sample size. The current study also focused on coping strategies as potential mediators of the labeling−sexual functioning relationships and did not assess for other potential variables of recovery such as posttraumatic stress symptomatology and social support. In addition, a relatively homogeneous and non-diverse sample of college women was utilized, and generalizations are thus limited to this population. However, college students are an important focus of study given their high rates of sexual victimization as well the developmental period where issues of sexuality and sexual functioning are prominent. Consideration of these limitations is important for conceptualization of the findings and for guiding future research.
Despite the limitations, there are several important clinical and research implications resulting from this study. For example, how labeling relates to coping efforts and belief systems about sexual and intimacy domains appears relevant in clinical settings. Women who do consider their experiences to be sexual assault may benefit from guidance on successfully accommodating their conceptualization of the experience with their belief systems and current sexual experiences in a non-maladaptive way. Treatment focusing on decreasing anxious coping among women who are in the process of conceptualizing their experience as sexual assault would be beneficial as well. Also, research examining the bivariate relationship between labeling and health outcomes may be insufficient for identifying a possibly more complex relationship, such as mediation. Future research that assesses these variables over time, such as with a longitudinal design, will shed light on potentially more indirect relationships between labeling, coping, and sexual functioning. Furthermore, the use of statistical methods such as hierarchical linear modeling can identify potential dynamic relationships between these variables over time. In addition, given the preliminary evidence of an indirect relationship between labeling and sexual functioning, future research should examine the role of additional potential mediators and moderators of this relationship (e.g., social reactions to disclosure, relationship variables).
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.