The Victim-Perpetrator Relationship and Peritraumatic Schemas as a Result of Sexual Trauma

Abstract

The development of posttraumatic stress symptoms (PTSS) due to sexual trauma is complex. Various mechanisms have been studied to explain the relationship between sexual trauma and PTSS. Other studies have looked at the impact of the victim-perpetrator relationship on the relationship between sexual trauma and PTSS with mixed results. Lacking from the literature is the possible mediating effect of peritraumatic schemas for the relationship between sexual trauma and PTSS. Additionally, the impact of the type of victim-perpetrator relationship may have on the development of peritraumatic schemas has also been unaddressed. This study seeks to close the gap in the literature by asking if peritraumatic schemas mediate the relationship between sexual trauma, specifically attempted and completed rape, and PTSS. The moderating role of the victim-perpetrator relationship on the association between sexual trauma and peritraumatic schemas was also examined. Using a college student sample that had endorsed experiencing at least one sexual trauma in their life, this study examined path analysis model explaining the mediating effects of peritraumatic schemas and the moderating effects of the victim-perpetrator relationship. Results indicated that peritraumatic schemas partially mediated the relationship between attempted rape and PTSS when controlling for completed rape. This effect was not found for the relationship between completed rape and PTSS when controlling for attempted rape. The interaction between attempted rape and the acquaintance perpetrator relationship was significant, indicating that peritraumatic schemas increased more severely for those that experienced attempted rape by an acquaintance. Recognizing that PTSS partially results from the peritraumatic schemas experienced, which are impacted by the victim-perpetrator relationship, helps increase understanding of the experience of attempted rape.

Keywords

sexual trauma peritraumatic schemas perpetrator victim posttraumatic stress disorder

Sexual trauma is any non-consensual sexual contact and can involve the use of threat, force, or coercion (Center for Disease Control [CDC], 2021). It is a prevalent issue in society with about 44% of women and 25% of men reporting experiences of sexual trauma (Smith et al., 2018). The outcomes of sexual trauma are well documented. Anxiety, depression, posttraumatic stress disorder (PTSD), difficulty with relationships, and risk of revictimization are all prevalent outcomes (Dworkin et al., 2017; Mason & Lodrick, 2013). Several mechanisms can explain how these outcomes come about, including maladaptive coping (Choi et al., 2015), level of social support (Ullman & Peter-Hagene, 2016), the perceived severity of the trauma (Lauricella & Jones, 2020), the level of threat involved (Ullman et al., 2007), etc. Although there are multiple studies regarding how and why various outcomes of sexual trauma come about, peritraumatic schemas are missing from the literature. Peritraumatic schemas are the beliefs that one holds about themselves, others, and the world during and immediately after the trauma (Brunet et al., 2001; Janoff-Bulman, 1989; Wright et al., 2010). Traumatic experiences can impact schemas post-trauma (Karatzias et al., 2016; Littleton et al., 2012; Wright et al., 2010), but understanding how what a trauma survivor thinks and believes in the moment of trauma impacts outcomes is not known. It is possible that peritraumatic schemas are associated with posttraumatic stress symptoms (PTSS), but this has not been assessed.

In addition to a lack of knowledge regarding the association of peritraumatic schemas and PTSS, understanding how the victim-perpetrator relationship impacts this association is also lacking. Evidence exists that the victim-perpetrator relationship is important to the sequelae of sexual trauma (Lundrigan, 2014; Temple et al., 2007; Ullman & Siegel, 1993). It is also possible that the victim-perpetrator relationship is associated with the peritraumatic schemas experienced by the victim, meaning the beliefs the victim has about themselves, others, and the world may vary during sexual trauma depending on their relationship with the perpetrator. However, this has not yet been examined. Thus, the purpose of this study is to 1) assess the mediating role of peritraumatic schemas of the relationship between sexual trauma and PTSS and 2) assess whether the development of peritraumatic schemas depends on the victim-perpetrator relationship.

Sexual Trauma and Posttraumatic Stress Disorder

Sexual trauma is a widespread concern and happens frequently in college age individuals in the United States (Black et al., 2011; Sabri et al., 2019; Snipes et al., 2017). The Association of American Universities’ 2019 Campus Climate Survey found that 26.4% of undergraduate women and 6.9% of undergraduate men enrolled at participating schools had experienced non-consensual sexual conduct by force or inability to consent (Cantor et al., 2020), leading this population to be at high risk for outcomes related to sexual trauma. Research has shown that sexual trauma can lead to depression, anxiety, fear, and increased social impairment (Dworkin et al., 2017; Karatzias et al., 2016; Ullman et al., 2007; Ullman & Siegel, 1993). PTSD is also a common psychological outcome of sexual trauma (Dworkin et al., 2017; Mason & Lodrick, 2013; Möller et al., 2014; Perilloux et al., 2012; Peter-Hagene & Ullman, 2015; Snipes et al., 2017; Ullman & Peter-Hagene, 2016).

Individuals who have experienced interpersonal traumas (i.e., trauma experienced at the hands of another person), such as sexual trauma, have higher rates of PTSS than those who have experienced non-interpersonal traumas (Feinstein et al., 2011; Hetzel-Riggin & Roby, 2013). The likelihood of developing PTSS increases further for survivors of sexual assault (Feinstein et al., 2011; Snipes et al., 2017). It is estimated that around 33–60% of rape victims are diagnosed with PTSD at some point after their assault (Feinstein et al., 2011; Möller et al., 2014; Ullman et al., 2007; Ullman & Peter-Hagene, 2016). Factors leading to more severe PTSD symptoms include extreme violence in the assault, perceived life threat, alcohol use prior to assault, completed rape, and negative social reactions to disclosure (Peter-Hagene & Ullman, 2015; Ullman et al., 2007; Ullman & Peter-Hagene, 2016). Research has shown that the presence of PTSS and traumatic distress may be linked to an incongruency between an individual’s prior schemas, or beliefs, about themselves, others, and the world and their schemas after the sexual trauma (Cason et al., 2002; Janoff-Bulman, 1989).

Sexual Trauma and Peritraumatic Schemas

An individual’s beliefs and understanding of oneself, others, and the world are known as schemas (Harris & Valentiner, 2002; Janoff-Bulman, 1989; Wright et al., 2010). They develop through the processing of information that comes through life experiences and become more solidified with time and exposure to various events that support the schema (Stein, 1992; Thorndyke & Hayes-Roth, 1979). Schemas guide each person’s interpretation and integration of new information, as well play a role in how one interacts with the world and others (Cason et al., 2002; Harris & Valentiner, 2002). They are believed to be self-perpetuating and challenging to change (Harris & Valentiner, 2002; Stein, 1992; Thorndyke & Hayes-Roth, 1979). Even so, schemas are modifiable through events and experiences that do not fit with one’s current understanding of the world. Events that are new, challenge one’s current understanding of the world, and one’s perception of their place and safety in the world can leave existing schemas vulnerable to disruption (Cason et al., 2002); changes in schemas result in changes to how one views and interacts with the world. Sexual trauma is an experience that can create immediate and long-term distress in victims which can drastically impact their schemas about themselves, the world, and others both during the trauma (i.e., peritraumatic schemas) and permanently thereafter (posttraumatic schemas; Janoff-Bulman, 1989; Karatzias et al., 2016; Littleton et al., 2012; Wright et al., 2010).

The schemas that sexual trauma victims have during or immediately after the traumatic event are peritraumatic schemas (Brunet et al., 2001). Peritraumatic schemas are unique in that they may resemble nontraumatic schemas, posttraumatic schemas, or something entirely different. In other words, one’s schemas may or may not be impacted by trauma. Peritraumatic schemas may not change from their pre-traumatic schemas. The sexual trauma may be an experience that is new or intense enough that the schemas the survivor has in the moment of trauma shift or change rapidly. They may impact future schemas and the survivor’s later mental and emotional health (Harris & Valentiner, 2002). Peritraumatic schemas vary between sexual trauma survivors and can be influenced by the trauma itself (Brunet et al., 2001). Factors such as intensity of the trauma, whether the survivor has previous experiences of trauma, and the relationship between the survivor and perpetrator could all potentially impact the schemas during a traumatic experience (Brunet et al., 2001). It is important to understand peritraumatic schemas to better help survivors heal from sexual trauma.

Research regarding peritraumatic schemas is scarce; however, there is existing research on other aspects of the peritraumatic experience, including peritraumatic dissociation (Kumpula et al., 2011; Rizvi et al., 2008; Thompson-Hollands et al., 2017), peritraumatic emotions (Lancaster & Larsen, 2016; Peter-Hagene & Ullman, 2015), and other various peritraumatic responses (Feinstein et al., 2011; Rizvi et al., 2008). Previous research (Feinstein et al., 2011; Kumpula et al., 2011; Lancaster & Larsen, 2016; Peter-Hagene & Ullman, 2015; Thompson-Hollands et al., 2017) shows that the peritraumatic experience is a key aspect in outcomes that develop. Research has indicated an association between peritraumatic fear, anger, shock, guilt, shame, disgust, and PTSD severity, with peritraumatic emotions and posttraumatic intrusion symptoms, and identified peritraumatic negative affect as a predictor of posttraumatic depression (; Feinstein et al., 2011; Lancaster & Larsen, 2016; Rizvi et al., 2008). Missing from these peritraumatic experiences is assessment of the beliefs and assumptions that the victim held during and directly after the sexual trauma (i.e., peritraumatic schemas).

Relationship with Perpetrator

Victim-perpetrator relationships can be broken down into the categories of stranger, acquaintance, and intimate partner. A majority of sexual assault is committed by someone the victim knows, followed by acquaintances (Department of Justice, 2017). Research has shown that the relationship to the perpetrator is important when understanding the effects of sexual assault (Feinstein et al., 2011; Temple et al., 2007); however, the existing literature provides conflicting results about how the relationship impacts outcomes for the victims of sexual trauma. Some studies have found current-partner sexual assaults predict PTSD symptoms at a higher rate and severity than assaults committed by an unknown assailant (Lawyer et al., 2006; Temple et al., 2007) while other studies record opposite findings (Feinstein et al., 2011; Ullman et al., 2006). Other studies have found no differences in PTSS severity as related to varying assailant types (Domino et al., 2020). Further research has argued that variations in outcomes for victims of sexual trauma can be attributed to the schemas related to the relationship rather than the relationship type itself (Wright et al., 2010). For example, if sexual trauma victims place blame on themselves for being over-trusting of a current/former partner, acquaintance, etc., their pre-existing schemas regarding trust may be disrupted or disturbed. Disrupted schemas can lead to distorted beliefs such as believing they cannot trust anyone or that their judgment is unreliable (Wright et al., 2010), increasing the likelihood of PTSD development.

The Present Study

Experiences of sexual trauma often result in the development of PTSS (Dworkin et al., 2017) and a variety of mechanisms exist to explain this relationship (Choi et al., 2015; Lauricella & Jones, 2020; Snipes et al., 2017; Ullman et al., 2007). Peritraumatic schemas may be an additional mechanism that explains the relationship between sexual trauma and PTSS, but this has not been examined. Additionally, although there is literature discussing the importance of the relationship between the victim and the perpetrator on the resulting outcomes, the conclusions are mixed (Lundrigan, 2014; Temple et al., 2007; Ullman & Siegel, 1993). Clarifying the role of peritraumatic schemas and how they may depend on the victim-perpetrator relationship can help to understand the various factors that impact the development of PTSS because of sexual trauma. This study seeks to assess whether peritraumatic schemas mediate the relationship between sexual trauma and PTSS and examine if peritraumatic schemas present in the moment of sexual trauma are moderated by the relationship between the victim and the perpetrator.

Methods

Procedure

Data for this study was collected at a public university in the south-central United States. Participants were recruited through the university’s SONA System, a platform for students to locate and participate in various research studies happening on the university campus. Students were free to read the study description and choose whether to participate in the study. Those that chose to participate in the study were asked to consent to participate. If consent was given and the participant was over 18 years of age, they were administered an online survey that asked questions regarding previous trauma experiences, experiences of sexual trauma including questions about severity and type, peri and posttraumatic schemas, anxiety, depression, posttraumatic stress disorder, couple relationship satisfaction, and changes in sexual functioning. Participants were instructed to answer the survey about their most distressing sexual trauma if they had experienced more than one event. Those that participated and completed the survey received up to one-point of course extra credit. All procedures were approved by the university’s Institutional Review Board.

Participants

Participants for this study (N = 756) were undergraduate students at a south-central university in the United States. About 76% of the sample identified as female (n = 573) with about 24% (n = 180) identifying as male. The average age was 21.2 years. Participants were evenly distributed across the length of time they had been in college, with about 21% reporting freshmen status, 25% as having 2 years of college education, 28% as having 3 years of college experience, and 21% as identifying as senior status. About 5% identified as having five or more years of undergraduate schooling.

Measures

Sexual Assault Severity . Participants completed a modified version of the Sexual Assault Severity Scale (SASS)—Severity Subscale to account for the severity of their experiences with sexual assault (Swinson, 2013). The modified SASS—Severity Subscale asked participants to identify types of unwanted sexual contact they may have had throughout their life (instead of experiences from age 18 years and older) and whether these sexual experiences were an attempt or were a completed assault (e.g., “Someone TRIED to perform oral sex on you,” “Someone performed oral sex on you”). The questions used for this study asked about oral, vaginal, and anal sexual acts (i.e., the question regarding unwanted touch was excluded). Responses were scored on a scale ranging from 1 (Never) to 4 (Three times or more). Because previous literature supports the idea that attempted sexual assault and completed sexual assault are not comparative (Dworkin et al., 2017), two variables were created from this scale. Responses regarding attempted assault (further referred to as attempted rape) were averaged to create a mean attempted rape score. Responses regarding completed assault (further referred to as completed rape) were averaged to create a mean completed rape score. Alpha scores indicated adequate reliability for attempted rape (a = 0.78) and for completed rape (a = 0.77).

Victim-Offender Relationship. Participants were asked to define their relationship with the offender using the Victim-Offender Relationship Subscale of the SASS (Swinson, 2013). They were asked a categorical question to define how they knew the person with options including stranger, friend/previous intimate partner, someone you just met (i.e., acquaintance), and intimate partner. Four dichotomous variables were created for each type of victim-offender relationship. Variables coded with a 1 were indicative of that kind of offender relationship.

Peritraumatic Schemas . The SASS includes a scale assessing peritraumatic schemas specific to sexual trauma (Swinson, 2013). This is a thirteen-item scale that asks participants about thoughts or beliefs they might have experienced during or immediately after their sexual trauma (e.g., “This sexual experience happened because I am too trusting of others,” “I feel broken or damaged,” “The world is a dangerous place”). Items were structured to identify which thoughts participants might have experienced during the sexual trauma event. If multiple events of sexual trauma were endorsed, participants were prompted to consider their most distressing experience. Although there were no specified subscales, items focused on three areas of perception: safety, self-blame, and the world. Responses were rated on an 11-point scale (0 = Strongly disagree, 10 = Strongly agree). Higher scores indicated greater rates of negative peritraumatic schemas. Alpha scores indicated good reliability (a = 0.88).

Posttraumatic Stress Symptoms. Participants completed the PTSD Checklist for DSM-5 (PCL-5) to report on symptoms of PTSD (Weathers et al., 2013; Wortmann et al., 2016). Questions asked how often the participant had experienced various PTSD symptoms over the past month (e.g., “Repeated, disturbing, and unwanted memories of the stressful experience,” “Trouble remembering important parts of the stressful experience,” “Being ‘superalert’ or watchful or on guard”). Responses were recorded on a 5-point scale (0 = Not at all, 1 = A little bit, 2 = Moderately, 3 = Quite a bit, 4 = Extremely). Items were averaged to create an overall score with higher scores indicating greater PTSD symptomology. Average scores ranged from 0 to 4. Alpha scores indicated excellent reliability (a = 0.95).

Data Analysis Plan

Data was cleaned, composite variables created, and descriptives and correlations assessed using SPSS v 26 (IBM Corp., 2017). A path model was fit using Mplus v 8.6 (Muthén & Muthén, 2017). The path model included sexual trauma (i.e., attempted and completed rape) as predictors and PTSD as an outcome. Attempted and completed rape were separate predictors but assessed simultaneously. Peritraumatic schemas was then added to the model as a mediator. If full or partial mediation was supported, as indicated by significant indirect effects and confidence intervals that do not include zero (MacKinnon et al., 2007), variables measuring the victim-offender relationship were added as a moderator to the path of sexual trauma predicting peritraumatic schemas (see Figure 1). Moderation would be considered significant if the p-value of the path was less than 0.05. Model fit would be considered adequate if the chi-square statistic was low and non-significant, the RMSEA was 0.08 or lower, the CFI is 0.90 or greater, the TLI is 0.90 or greater, and the SRMR is 0.05 or lower (Little, 2013).

Figure 1.

Proposed moderated mediation path model. Note. Attempted rape and completed rape were examined as separate variables but were included as one in the figure for ease of reading. IP = Intimate Partner.

Results

Descriptives (see Table 1) indicated that the current sample had mild levels of negative peritraumatic schemas and that most of the offenders were acquaintances. Strangers were the least common type of offender relationship in the data. Average rates of PTSS, as well as severity of attempted and completed rape, were low. Bivariate correlations showed that there were significant positive correlations between attempted rape, completed rape, and PTSS, as well as attempted rape, completed rape, and peritraumatic schemas (see Table 1). PTSS and peritraumatic schemas were also positively correlated.

Table 1.

Descriptives and Correlations for All Variables.

	%	M	SD	1	2	3	4	5
1. Age		21.18	3.84	—
2. Attempted rape		1.61	0.76	0.06	—
3. Completed rape		1.40	0.64	0.09^a	0.75^b	—
4. Peritraumatic schemas		4.23	2.20	0.04	0.19^b	0.15^b	—
5. PTSS		0.78	0.78	−0.01	0.32^b	0.29^b	0.36^b	—
Gender
Male	23.8
Female	75.8
Victim-offender relationship
Acquaintance	32.1
Friendship/Previous IP	29.1
Intimate partner	12.7
Stranger	6.6

Note. PTSS = posttraumatic stress symptoms, IP = Intimate Partner.

^a< 0.05.

^b< 0.01; ***< 0.001.

The first step in conducting the moderated mediation path analysis (see Table 2) indicated that both attempted rape (b = .23, p < .001) and completed rape (b = .14, p < .05) were significantly associated with PTSS. For every one-unit change in attempted rape there is an average 0.23 unit change in PTSS while also controlling for completed rape. For every one-unit change in completed rape, there is an average 0.14 unit increase in PTSS while also controlling for attempted rape. Gender was also significantly associated with PTSS (b = .22, p < .001) indicating that women experienced higher rates of PTSS symptoms than men when accounting for other study variables. As both attempted and completed rape were significant predictors of PTSS symptoms, analyses proceeded to examine the mediating role of peritraumatic schemas. Results indicated that peritraumatic schemas were significantly associated with PTSS (b = 0.11, p < 0.001). For every one-unit change in peritraumatic schemas there was an average 0.11 unit change in PTSS. Attempted rape remained significantly associated with PTSS (b = .18, p < .01), but the effect size and significance level decreased. Completed rape was no longer significantly associated with PTSS when peritraumatic schemas were included in the model. Attempted rape was significantly associated with peritraumatic schemas (b = .48, p < .01). For every one-unit change in attempted rape, there is an average 0.46 unit change in peritraumatic schemas. This is a medium to large effect. Indirect effects were examined and indicated that there was a significant indirect effect from attempted rape to PTSS through peritraumatic schemas (b = .05, p < .05). Confidence intervals at the 95% level also supported significant indirect effects (95% CI 0.01–0.11).

Table 2.

Path Analysis Results.

	Predictor	Mediator	Outcome	b (SE)		B	95% CI
Step 1
	Age		PTSS	−0.01 (0.01)		−0.02
	Gender		PTSS	0.22 (0.07)^a		0.12
	Attempted rape		PTSS	0.23 (0.06)^a		0.22
	Completed rape		PTSS	0.14 (0.06)^b		0.12
Step 2
	Age		PTSS	−0.01 (0.01)		−0.04
	Gender		PTSS	0.15 (0.07)^b		0.08
	Attempted rape		PTSS	0.18 (0.06)^c		0.14
	Completed rape		PTSS	0.10 (0.07)		0.13
	Peri schemas		PTSS	0.11 (0.02)^a		0.30

	Age		Peri schemas		0.03 (0.03)	0.05
	Gender		Peri schemas		0.66 (0.24)^c	0.13
	Attempted rape		Peri schemas		0.46 (0.17)^c	0.16
	Completed rape		Peri schemas		0.09 (0.21)	0.03

Total effect	Attempted rape	Peri schemas	PTSS	0.23 (0.06)^a		0.22
Indirect effect	Attempted rape	Peri schemas	PTSS	0.05 (0.02)^b		0.05	0.01–0.11
Step 3
	Age		PTSS	−0.01 (0.01)		−0.08
	Gender		PTSS	0.17 (0.09)		0.08
	Attempted rape		PTSS	0.24 (0.06)^a		0.23
	Peri schemas		PTSS	0.13 (0.02)^a		0.37

	Age		Peri schemas	0.04 (0.04)		0.07
	Gender		Peri schemas	1.19 (0.33)^a		0.21
	Attempted rape		Peri schemas	1.59 (1.13)		0.55
	Stranger		Peri schemas	0.13 (0.13)		0.18
	Acquaintance		Peri schemas	−3.73 (0.96)^a		−0.46
	Intimate partner		Peri schemas	−0.86 (0.68)		−0.19
	Friend		Peri schemas	−0.12 (1.11)		−0.02
	AR x stranger		Peri schemas	−0.10 (0.07)		−0.55
	AR x acquaintance		Peri schemas	1.54 (0.05)^c		0.36
	AR x IP		Peri schemas	0.53 (0.38)		0.21
	AR x friend		Peri schemas	0.02 (0.52)		0.01

Note. PTSS = Posttraumatic Stress Symptoms, AR = Attempted Rape, IP = Intimate Partner.

^b< 0.05.

^c <0.01.

^a <0.001.

The moderating effect of the victim-offender relationship on the relationship between attempted rape and peritraumatic schemas was added in step three. Results indicated that the interaction between attempted rape and the offender relationships of stranger, friend/previous intimate partner, and intimate partner were not significant. However, the acquaintance offender relationship significantly moderated the path between attempted rape and peritraumatic schemas (b = 1.54, p < .01; see Figure 2). Those that experienced attempted rape by an acquaintance had higher levels of peritraumatic schemas at high levels of attempted rape severity than those whose perpetrators were non-acquaintances. Those that experienced attempted rape by a non-acquaintance perpetrator started out with higher negative peritraumatic schemas than those whose perpetrators were acquaintances at low attempted rape severity.

Figure 2.

Interaction between attempted rape and acquaintance offender relationship on peritraumatic schemas.

Discussion

The purpose of this study was to assess the role of peritraumatic schemas between sexual trauma and PTSS. Additionally, the role of the victim-perpetrator relationship was assessed as a moderator of the relationship between sexual trauma and peritraumatic schemas. Results indicated that peritraumatic schemas partially mediated the relationship between attempted rape and PTSS, highlighting how changes in one’s perceptions of safety, trust, and self in the world are connected to PTSS. However, this relationship was not found for completed rape when controlling for attempted rape. Additionally, the relationship between attempted rape and peritraumatic schemas was moderated only if the perpetrator was an acquaintance, indicating that the relationship between the victim and the perpetrator is important in understanding the schemas the victim holds in the moment of trauma.

Completed rape was positively associated with PTSS before adding the mediator of peritraumatic schemas. However, when peritraumatic schemas was added to the model, completed rape was no longer associated with PTSS, nor with peritraumatic schemas, when also controlling for attempted rape. The relationship between rape and PTSS is complex with various factors playing a role in the development of PTSS due to sexual trauma (Lauricella & Jones, 2020; Möller et al., 2014; Snipes et al., 2017). When assessing the basic relationship between rape and PTSS, it often is found to be significantly related (Dworkin et al., 2017; Hetzel-Riggin & Roby, 2013; Lauricella & Jones, 2020; Snipes et al., 2017). However, often, this relationship can also be explained by other factors that highlight mechanisms and strengths of the relationship between rape and PTSS, such as the victim’s perceived severity of the event (Lauricella & Jones, 2020), alcohol and substance use (Peter-Hagene & Ullman, 2015), maladaptive coping (Choi et al., 2015), level of violence involved in the assault (Peter-Hagene & Ullman, 2015), beliefs about sex and power (Snipes et al., 2017), gender (Hetzel-Riggin & Roby, 2013; Lauricella & Jones, 2020), and even the response of others upon disclosure (Ullman & Peter-Hagene, 2016). As such, it is not surprising that adding various controls and moderators to the model would lead to decreased significance in the direct relationship between completed rape and PTSS. It is possible that those that experience completed rape are more prone to experiencing peritraumatic dissociation (Wilson & Scarpa, 2012), leading them to have a difficult time remembering what schemas were in place during or directly after the sexual trauma, resulting in a lack of relationship between completed rape and peritraumatic schemas.

Interestingly, peritraumatic schemas partially mediated the relationship between attempted rape and PTSS when controlling for completed rape, highlighting that how one views themselves, others, and the world in the moment of trauma plays a role in the development of PTSS (Brunet et al., 2011). As part of PTSD criteria focuses on schemas and cognitions (American Psychiatric Association, 2013; Thompson-Hollands et al., 2017), it is logical that the thoughts one has while experiencing a sexual trauma would then later impact their cognitions associated with PTSS. However, attempted rape continued to be a significant predictor of PTSS even after adding peritraumatic schemas to the model. Experiencing an attempted rape may hold a unique horror for those that are victimized. Although the negative sequalae of attempted rape differs in severity from those that experience completed rape (Lauricella & Jones, 2020; Perilloux et al., 2012), those that experience an attempt may not be as likely to dissociate through the experience (Wilson & Scarpa, 2012) allowing them to have clearer memories of the incident and their peritraumatic schemas. Having a clearer recollection of the trauma could lead to a stronger hold on negative peritraumatic schemas, including feelings of unsafety, insecurity, self-blame, and distance from others. Although not necessarily contradictory to the severity research regarding outcomes (Lauricella & Jones, 2020; Perilloux et al., 2012) the findings of this study do highlight that even an attempted rape has significant consequences, impacting how one views themselves, others, and the world. Although findings from this study are not all-encompassing, what has continued to be supported is that peritraumatic experiences do impact posttraumatic outcomes (Lancaster & Larsen, 2016; Wilson & Scarpa, 2012).

In addition to highlighting the importance of peritraumatic schemas in PTSS development, this study also furthers the understanding of what impacts peritraumatic schemas. The interaction between attempted rape and the acquaintance victim-perpetrator relationship clarifies how peritraumatic schemas are influenced by the relationship the victim has with the perpetrator. Results from the current study highlight that those that experience attempted rape by an acquaintance start at lower levels of negative peritraumatic schemas than those that experienced attempted rape by the hands of strangers, friends, and intimate partners. However, for those that experienced attempted rape at the hands of an acquaintance, they had higher levels of negative peritraumatic schemas the more severe their experience of attempted rape than their non-acquaintance abused counterparts (see Figure 2; see Feinstein et al., 2011). Those that experience attempted rape by an acquaintance may have their pre-trauma schemas challenged more strongly due to the newness and unfamiliarity of the relationship (Domino et al., 2020). This may lead victims to be more cautious at the start of the relationship, but these cautions possibly turn into intense negative peritraumatic schemas during a severe attempted rape. Those that experience attempted rape at the hands of an acquaintance are also more likely to resist, resulting in greater levels of fear (Feinstein et al., 2011) that may also impact peritraumatic schemas. Those that are victimized by a non-acquaintance (i.e., friends and intimate partners) may have already developed their peritraumatic schemas due to the likelihood that their sexual trauma is continuous rather than one event (Feinstein et al., 2011; Temple et al., 2007). They may have a slower increase in negative peritraumatic schemas either because they have been hurt by the same person before (Temple et al., 2007) or the levels of fear are lower compared to those that experience sexual trauma at the hands of an acquaintance (Feinstein et al., 2011).

Although clarifying the relationship between the victim-perpetrator relationship, peritraumatic schemas, and PTSS is an important step in better understanding the risk and severity factors associated with sexual trauma, one thing this study lacks is the exploration of how these relationships may differ for men and women, as well as those that identify as a racial/ethnic or sexual identity minority. Most of the sexual trauma literature focuses on women as victims and men as perpetrators. However, literature also highlights how sexual trauma happens in populations of men and across all races and ethnicities (Stemple & Meyer, 2014). Although the current study controlled for gender, understanding the relationships that exist for these diverse populations would help to create more inclusive treatment plans for survivors. This would also require ensuring that schemas regarding trust, intimacy, and safety are similar for these groups. Because the data for this study did not assess racial/ethnic and sexual identity, it would be prudent for future research to include these factors into the current model.

Limitations and a Discussion of Study Diversity

This study does add to the field of knowledge regarding sexual trauma, specifically regarding sexual trauma, victim-perpetrator relationship, and peritraumatic schemas. Like any study, however, there are also limitations that should be addressed in future research. Some limitations are methodological in nature. Most importantly, all data was collected via self-report and asked about information retrospectively. This process may inhibit the gathering of accurate data for peritraumatic schemas as it requires participants to recall specific thoughts and feelings at a specific moment. Not only is it difficult to assess the accuracy of the peri-traumatic schema measures, it could also lead to response bias and bias due to social desirability, thus affecting the results of the study. However, even though self-report is not an ideal way of collecting data, the study would not be possible with other data collection means. Lastly, the study did not account for other traumatic experiences that may have contributed to the participant’s endorsement of PTSS. As these events were not controlled for in the analyses, results should be interpreted with caution.

Other limitations consisted of issues regarding sampling and diversity. First, the sample was comprised of college students. Although there is literature stating that dating violence and sexual assault is common among this population (Black et al., 2011; Sabri et al., 2019), it is also a unique time of life and development that may result in different outcomes if the population were more diverse in age and phase of life. Additionally, the population was also predominantly comprised of women. Men have been reported to have sexual trauma experiences more often than acknowledged (Stemple & Meyer, 2014). Additionally, responses to sexual trauma have also been shown to differ between men and women (Hetzel-Riggin et al., 2013; Lauricella & Jones, 2020). Thus, further research should work to provide victimized men more of a voice in their experiences of peritraumatic cognitions and how that may impact the possible outcome of PTSS. Additionally, the data used for this study did not account for race/ethnicity; identifying if the model would fit differently depending on race or ethnicity would also be prudent for further research.

While this study does further understanding of various aspects of sexual trauma, it also highlights the need for more diverse sampling in sexual trauma research. Diversity in both gender and race/ethnicity were lacking from this study, highlighting the need for future research to be more conscious in sampling. Ensuring that future research is more inclusive of differences in gender and race/ethnicity will allow greater understanding on how sexual trauma may impact people from a variety of backgrounds differently. The lack of including race/ethnicity in analyses, as well as sampling for a larger population of men, leads for future research to implement these important aspects of diversity into understanding the impact of sexual trauma.

Conclusion

Although the peritraumatic experience and its relationship with PTSS are considered in previous research, peritraumatic schemas are often overlooked. According to the current study, they do play a role in the development for those that experience attempted rape by an acquaintance. Additionally, not only do peritraumatic schemas explain part of the relationship between attempted rape and PTSS, the severity of the peritraumatic schemas experienced depends on the victim’s relationship with the perpetrator, highlighting the importance of understanding not only the severity of the experienced sexual trauma, but who perpetrated the sexual trauma and how that impacted the victim’s beliefs about themselves, the world, and others.

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.

ORCID iDs

Danielle Lauricella

Makayla Gregory

Author Biographies

Danielle Lauricella, M.S. LMFT-A, is a doctoral candidate in the Couple, Marriage, and Family Therapy program at Texas Tech University. Both her clinical and research interests focus on sexual trauma. She is currently an outpatient therapist and clinic administrator while completing her PhD She enjoys running, yoga, and spending time with her husband and dog.

Laura Eichenberger, M.S. LMFT-A, is a graduate of Texas Tech University’s Couple, Marriage and Family Therapy Masters program. She is currently a Licensed Marriage and Family Therapist Associate working for Community Health Network as a school-based therapist in Indianapolis, Indiana. Laura enjoys working with at-risk and underserved teens and their families as they navigate trauma, anxiety, depression and a variety of other presenting problems. In her free time Laura enjoys spending time with family, running, and trying new coffee shops.

Makayla Gregory, M.S. LMFT Candidate, recently received her master’s degree in Couple, Marriage, and Family Therapy from Texas Tech University. She is now an LMFT Candidate in the state of Oklahoma. Her clinical and research interests center around working with couples as well as individuals who have experienced trauma. She has presented theoretically driven posters at local conferences. She has also submitted a publication surrounding working with individuals who have a chronic illness.

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