Psychosocial Sequalae of Sexual Assault in a Sample of Partnered Adults Experiencing Alcohol Use Disorder and Intimate Partner Violence

Abstract

Research has shown that experiencing a sexual assault results in significant and lasting effects in many psychosocial domains. However, most studies on the impact of sexual assault examine university samples or the immediate aftermath of the assault, not taking into account the longer-term complexities and contexts of life for many victims. The current study seeks to evaluate the role of lifetime sexual assault history on several psychosocial outcomes in adults who are in intimate relationships that have included both intimate partner violence (IPV) and alcohol use disorder. The study included 100 adult romantic couples who were part of a larger project addressing violence and alcohol use. A majority of participants were Caucasian (74.3%) and female (53%). Participants reported on lifetime sexual assault history, depression, perceived stress, maladaptive cognitive emotion regulation, and perceived intimate relationship functioning. Multilevel analyses controlled for couple interdependence as well as current levels of alcohol use and IPV. Results indicated that the presence/absence of sexual assault was only related to perceived life stress (p = .016), while the total number of lifetime assault experiences was related to depression symptoms (p < .001), perceived life stress (p = .052), maladaptive cognitive emotion regulation (p = .048), and dyadic adjustment (p = .003). These findings underscore the importance of investigating sexual assault outcomes in complex populations, as well as the need for more thorough and regular assessment of sexual assault history. Focusing on empowerment and recovery for sexual assault victims of any age is an important tool to prevent the detrimental outcomes that particularly accompany multiple victimizations.

Keywords

sexual assault intimate partner violence alcohol mental health relationships

Sexual assault affects 17 to 25% of women and 1 to 3% of men across the lifespan, with unwanted sexual experiences ranging from childhood sexual abuse to assault in adolescence and college to military sexual victimization (Black et al., 2011; Fisher et al., 2000; Post et al., 2011; Wilson, 2016). Significant research has shown that at any age and with any personal identity (i.e., gender, race, ethnicity) or assault circumstances, unwanted sexual experiences take a serious toll on mental health. Research on victimization generally also suggests a dose-response effect such that increased exposure to various traumas results in increased negative consequences (Blanco et al., 2022; Charak et al., 2020; Turgumbayev et al., 2023). Past studies have also shown that exposure to sexual trauma puts victims at risk for repeated violent victimization, including subsequent sexual violence and intimate partner violence (IPV; Decker & Littleton, 2018; Spencer et al., 2019). Given the high frequency of these unwanted sexual experiences and the concerning sequelae of them, it is important to understand and mitigate the long-term risks and consequences for victims, especially those in complex situations that put them at high risk for revictimization.

Sexual Assault and Mental Health

Sexual assault in adulthood has a negative effect on various aspects of mental health, with victims experiencing symptoms of depression, posttraumatic stress, perceived stress, anxiety, substance use, and suicidal ideation (e.g., Campbell et al., 2009; Catabay et al., 2019). Victims of childhood sexual abuse show distress in both the short term and the long term (Dworkin et al., 2017). In both cases, risk for further victimization is heightened, particularly when individuals are experiencing distress related to the assault, and in turn, revictimization worsens mental health (Littleton & Ullman, 2013; Spencer et al., 2019). One aspect of mental health that appears to be particularly affected by sexual assault and the distress it causes is emotion regulation. For example, alcohol use and, in particular, drinking to manage emotions has been shown to be both a risk factor for and a consequence of sexual assault (Cloitre et al., 2006; Kirkner et al., 2018; Shannon et al., 2008). Research has also shown that disengaged coping and self-blame relate to higher levels of mental health symptoms and that self-blame uniquely predicts risk for revictimization (Abrahams et al., 2013; Hamrick & Owens, 2019).

Sexual Assault and Relationships

The aftereffects of trauma experiences, such as sexual assault, might be mitigated by strong social relationships and social support (e.g., Brunton & Dryer, 2022). However, relationships that are low quality can do more harm than good (Leonard & Eiden, 2007), and despite the benefits of social support after trauma, sexual assault might negatively impact one’s ability to engage adaptively in close relationships (Rothman et al., 2021). Childhood sexual abuse has specifically been shown to correlate with a loss of interpersonal resources (Schumm et al., 2004). A recent systematic review of sexual assault and romantic relationships found only 20 articles that address this topic, with mixed findings (Vitek & Yeater, 2021). On the whole, the literature suggests that having a history of sexual assault is related to lower satisfaction in relationships, but findings are complicated by methodological differences (i.e., studies that focus on adult-only vs. child-only assaults). Several researchers have theorized that sexual assault affects relationships due to the mental health and substance use sequelae (e.g., Georgia et al., 2018; Marshall & Kuijer, 2017). For example, Georgia et al. (2018) found that childhood sexual assault did not directly relate to adult relationship satisfaction but that lower adulthood emotional intimacy mediated this relationship. These complicated findings underscore the importance of understanding the impact of sexual assault on both individual and relational outcomes.

Complex Impact of Sexual Assault

To fully grapple with the associations among sexual assault, mental health, and relationships, it is essential to consider the intricate ways in which these issues merge in adulthood. Mental health often deteriorates after either sexual or physical assault, and mental health symptoms often co-occur with an increase in substance use (Campbell et al., 2009; Lee et al., 2009; Patton et al., 2022). The relationship between alcohol use and violence exposure is bidirectional, such that history of sexual or physical victimization is related to substance use, while substance use is also a risk factor for revictimization both of IPV (sexual or physical) or sexual violence from a stranger or acquaintance (i.e., Dworkin et al., 2017). And yet, rarely is the impact of sexual assault studied in a way that takes into account these many complexities. Limited data is available regarding the association between sexual assault and intimate relationship outcomes, and many studies focus on either child or adult sexual assault, but not the combination of the two (see Georgia et al., 2018, for an example of addressing both child and adult assault, and, Rothman et al., 2021, for a discussion of this issue). Studies that have looked at multiple victimization situations (i.e., history of sexual assault and other physical assault) have found that each type of assault is detrimental to mental health outcomes but that the effects are additive (Woerner et al., 2020). However, most studies focus specifically on one assault (either childhood history or a specific incident in college, for example) and do not account for multiple events over time (Dworkin et al., 2017). More research is needed to understand the impacts of sexual assault on multiple domains and inclusive of multiple types of sexual assault experiences.

Current Study

The current study seeks to address these gaps in the literature by evaluating the role of lifetime sexual assault history on several psychosocial outcomes in adults who are in complex intimate relationships. Data for this study are drawn from a larger project in which couples were intentionally recruited for recent relationship violence and at least one partner having a current alcohol use disorder. Thus, this sample offers a unique opportunity to investigate the effects of sexual assault in individuals who may be living at the intersection of trauma history, interpersonal violence, and mental health and substance use concerns. Specifically, this project examines individual depression, perceived stress, maladaptive cognitive emotion regulation, and perceived intimate relationship functioning as outcomes, controlling for couple interdependence as well as current levels of alcohol use and IPV. The intent of this study is to better understand the role that child, adolescent, and adult assaults may play in the daily life of individuals who are in complex situations that include issues common to sexual assault victims. We first hypothesize that simple presence of any sexual assault history will be related to psychosocial outcomes, including depression, stress, maladaptive emotion regulation, and intimate relationship functioning. We further hypothesize that higher frequency of sexual assault experiences across the lifespan will be more clearly related to significant impairment in each of these domains. We expect these effects to be shown above and beyond the impact of current alcohol use and relationship violence, both of which were inclusion criteria for the current study and which are relevant to the experience of sexual assault.

Method

Participants

Participants were adult romantic couples (N = 100; n = 92 different-sex couples and n = 8 same-sex couples) who were enrolled in a pre-registered randomized controlled trial examining the effects of a single dose of intranasal oxytocin on alcohol craving and intimate partner aggression in the laboratory (NCT03046836). Primary outcomes of the parent study along with full study procedures and sample characteristics were published previously (Flanagan et al., 2022). Inclusion criteria required that couples were in a committed relationship of at least 6 months duration and they endorsed at least one instance of physical IPV (i.e., hitting, slapping) during their current relationship. Additionally, at least one partner in each couple was required to meet DSM-5 (American Psychiatric Association, 2013) diagnostic criteria for current alcohol use disorder. Participants who reported a score ≥8 on the Clinical Institute Withdrawal Assessment for Alcohol (Sullivan et al., 1989) or severe and unilateral partner violence with their current partner, including current severe sexual assault, as assessed by the Revised Conflict Tactics Scale (CTS-2; Straus et al., 1996) were excluded for safety and provided with clinical referrals.

Participants were, on average, 34.4 years old (SD = 11.3) and most participants identified as women (53%). Most participants also identified as white (n = 138, 74.3%) and non-Hispanic (n = 184, 93.5%) and were cohabitating with, but not married to, their partner (n = 90, 43.2%). Participants reported an average relationship length of approximately 7.4 years (M = 89.2 months, SD = 93.5 months). Out of the 100 couples, there were 12 couples in which both partners reported a history of prior sexual assault and 58 couples where both individuals met criteria for alcohol use disorder.

Procedures

All study procedures were IRB-approved. Participants were recruited via internet advertisements (i.e., Craigslist, Facebook) and flyers posted in local community settings. Following an initial phone screening, participants completed private written informed consent apart from their partner and a baseline assessment consisting of self-report and interview measures. Participants were compensated for their time, earning up to $150 for a total of about 4 hours of participation for a baseline visit from which this data is drawn; for full details, see (Flanagan et al., 2022).

Measures

Lifetime Sexual Assault History

The Traumatic Life Events Questionnaire (TLEQ; Kubany et al., 2000) was a self-report measure used to assess the types and frequency of traumatic events experienced by participants. This study employed the 4 items focused on sexual assault: Items 15 (childhood sexual assault by someone 5+ years older), 16 (childhood sexual assault by someone of a similar age), 17 (sexual assault between ages 13–18), and 18 (adulthood sexual assault). Respondents indicated whether they had experienced the event in their lifetime as a binary (yes/no), and if yes, they indicated the frequency of such an experience (1, 2, 3, 4, 5, or 6+ times). Each of the four was accounted for separately, yielding a frequency count for the number of times a respondent had experienced a sexual assault across those types.

Maladaptive Cognitive Emotion Regulation Strategies

The 18-item Cognitive Emotion Regulation Questionnaire–short (Garnefski & Kraaij, 2006) is a self-report measure that assessed adaptive and maladaptive cognitive emotion regulation strategies. For the purpose of the present study, only the maladaptive cognitive emotion regulation strategies were used, which included four 2-item subscales: catastrophizing, self-blame, blaming others, and rumination. Participants rated items using a 1 (almost never) to 5 (almost always) Likert-type scale such that higher scores indicate greater use of maladaptive emotion regulation strategies. The internal consistency of the maladaptive subscale was α = .75 in our sample.

Depression Symptoms

The 9-item Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001) was a self-report measure used to evaluate depression symptoms. Participants rated how often they have been bothered by each of the symptoms over the past 2 weeks on a 4-point Likert-type scale ranging from 0 (not at all) to 3 (nearly every day). Higher scores reflect greater symptom severity, with scores greater than 10 indicating possible diagnosis of depressive disorder. The internal consistency of the PHQ-9 was α = .88 in our sample.

Perceived Stress

The 4-item Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983) was a self-report measure used to assess the degree to which one apprises their life to be stressful over the past month. The measure uses a 5-point Likert-type scale ranging from 0 (Never) to 4 (Very often). Two items are reverse-scored, and then items are summed for a total score ranging from 0 to 16, with higher scores reflecting greater perceived life stress. The internal consistency in the current sample was α = .75.

Dyadic Adjustment

The 32-item Dyadic Adjustment Scale questionnaire (DAS; Spanier, 1976) measured relationship functioning, with higher scores reflecting greater functioning. The measure uses a combination of Likert-type scales (ranging from 5 to 7-point scales) and yes/no items, which are scored such that total scores range from 1 to 151, with scores below 97 reflecting relationship distress. Each participant responds to the DAS individually, reflecting their own assessment of their relationship adjustment. The internal consistency in the current sample was α = .94.

Alcohol Problems

The 10-item self-report form of the Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) measured alcohol-related problem severity. Total scores range from 0 to 40, with higher scores indicating more severe alcohol-related problems. Sample items include, “How many drinks containing alcohol do you have on a typical day when you are drinking” and “Have you or someone else been injured as a result of your drinking?” The AUDIT is widely used and has demonstrated strong construct validity and internal reliability in a range of samples (Babor et al., 2001; De Meneses-Gaya et al., 2009; Saunders et al., 1993). The internal consistency in the current sample was α = .89.

Intimate Partner Violence

The 78-item CTS-2 (Straus et al., 1996) assessed the frequency of victimization and perpetration of physical, psychological, and sexual IPV, as well as the use of negotiation and reasoning to handle relationship conflicts in participants’ current relationships over the past 6 months. The 12-item physical IPV and 8-item psychological IPV subscales were used in the current analyses. Response options range from 0 (never in the past 6 months) to 6 (more than 20 times in the past 6 months). Three response options that depict a range (3 = 3–5 times in the past 6 months, 4 = 6–10 times, 5 = 11–20 times) were recoded to reflect the midpoint of that range, and the response option “more than 20 times in the past 6 months” was recoded as 25. Thus, total scores could range from 0 to 300 for physical IPV and 0 to 200 for psychological IPV. The CTS-2 has demonstrated strong internal consistency as well as construct and discriminant validity (Chapman & Gillespie, 2019; Straus et al., 1996). To minimize the effect of underreporting, a maximum scoring method was used (Taft et al., 2010, 2016). This method involves using the higher score between the participant’s own report of IPV perpetration or their partner’s report of IPV victimization for each item when calculating each participant’s IPV perpetration subscale scores. The internal consistency of the physical and psychological IPV subscales were α = .86 and α = .75, respectively.

Analytic Plan

Bivariate correlations were used to assess relationships between frequency of sexual assault events and all psychosocial variables. Point-biserial correlations assessed the relationship between presence or absence of sexual assault history with each of the psychosocial correlates.

Hypothesis testing was conducted within a multilevel mixture modeling framework (Kenny et al., 2006) using SPSS version 26. This approach uses a nested data structure to account for interdependence of data within dyads. Individual partners (Level 1) are nested within couples (Level 2). The current study focuses on individual-level predictors and outcomes while taking the dyadic interdependence of data into account. These models assessed how sexual assault history (either presence/absence or frequency in separate models) as an independent variable was associated with each of the psychosocial outcomes (depression, perceived stress, maladaptive emotion regulation, and perceived dyadic adjustment) as dependent variables. Each of the eight models also controlled for alcohol problems, psychological IPV, and physical IPV due to the high prevalence of these issues in the sample.

Results

Of the 200 total participants, all but 1 completed the TLEQ, and 71 individuals endorsed some experience of sexual assault across the lifespan. Of those 71, 17 identified as men and 54 identified as women. The average frequency of sexual assault among those who endorsed any history was 4.41 (SD = 3.66). There were 12 couples where both individuals reported a history of sexual assault.

Point-biserial correlations revealed that presence or absence of sexual assault history was not significantly associated with any of the psychosocial outcomes. Bivariate correlations demonstrated that the frequency of sexual assault experiences was significantly positively correlated with depression symptoms (r = .28, p < .001) and maladaptive cognitive emotion regulation strategies (r = .15, p = .036), and negatively correlated with dyadic adjustment (r = −.22, p = .002). All correlations are available in Table 1.

Table 1.

Means, SD, and Correlations Among Primary Variables.

Variable	M (SD)	1	2	3	4	5	6	7	8
1. Sexual assault Yes/No		1
2. Sexual assault severity/Frequency	1.57 (3.03)	.70***	1
3. Depression	5.38 (5.16)	.13	.28***	1
4. Stress	8.82 (5.24)	.12	.11	.23***	1
5. Maladaptive emotion regulation	18.96 (5.24)	.08	.15*	.25***	.13	1
6. Dyadic adjustment	105.63 (21.09)	−.05	−.22**	−.33***	−.13	−.19*	1
7. Alcohol problems	10.98 (7.64)	.04	.10	.33***	.17*	.13	−.15*	1
8. Psychological IPV	42.61 (32.66)	−.03	−.02	.20**	.09	.08	−.25***	.20**	1
9. Physical IPV	33.05 (32.75)	−.05	−.02	.11	.05	−.01	−.14*	.14*	.82***

Note. IPV = intimate partner violence; SD = standard deviation.

p < .05. **p < .01. ***p < .001.

Results of multilevel mixture modeling testing presence or absence of sexual assault history (while controlling for alcohol problems, psychological IPV, and physical IPV) predicting psychosocial outcomes identified that sexual assault history was significantly positively associated with perceived life stress (b = 0.58, p = .016), but not depression symptoms, maladaptive cognitive emotion regulation, or dyadic adjustment (see Table 2 for full results).

Table 2.

Results of Regressions Testing Dichotomous Experience of Sexual Assault Predicting Psychosocial Outcomes Controlling for Alcohol Problems and IPV.

Outcome	Predictors	b	SE	t	p	Confidence Interval
Outcome	Predictors	b	SE	t	p	Lower Bound	Upper Bound
Depression	Intercept	1.75	0.74	2.37	.019	0.29	3.20
	SA dichotomous	1.21	0.71	1.70	.091	−0.20	2.60
	Alcohol problems	0.20	0.05	4.30	<.001	0.10	0.29
	Psychological IPV	0.04	0.02	2.30	.023	0.01	0.08
	Physical IPV	−0.02	0.02	−1.23	.222	−0.06	0.01
Perceived Stress	Intercept	7.99	0.28	28.92	<.001	7.44	8.53
	SA dichotomous	0.58	0.24	2.43	.016	0.11	1.05
	Alcohol problems	0.04	0.02	2.79	.006	0.01	0.07
	Psychological IPV	0.01	0.01	1.31	.191	−0.00	0.02
	Physical IPV	−0.01	0.01	−1.05	.294	−0.02	0.01
Maladaptive emotion regulation	Intercept	17.43	0.78	22.31	<.001	15.89	18.97
	SA dichotomous	0.77	0.76	1.02	.310	−0.73	2.27
	Alcohol problems	0.07	0.05	1.48	.140	−0.02	0.17
	Psychological IPV	0.04	0.02	1.94	.054	−0.00	0.08
	Physical IPV	−0.03	0.02	−1.75	.081	−0.07	0.00
Dyadic adjustment	Intercept	113.37	3.23	35.06	<.001	106.99	119.74
	SA dichotomous	0.40	2.78	0.15	.885	−5.09	5.89
	Alcohol problems	−0.30	0.18	−1.68	.095	−0.66	0.05
	Psychological IPV	−0.23	0.07	−3.12	.002	−0.38	−0.08
	Physical IPV	0.15	0.07	2.38	.019	−0.03	−0.29

Note. Bolded predictors indicate clinical significance. SE = standard error; SA = sexual assault; IPV = intimate partner violence.

Models testing the frequency of sexual assault occurrences (while controlling for alcohol problems, psychological IPV, and physical IPV) predicting psychosocial outcomes demonstrated that frequency of sexual assault history was significantly positively associated with depression symptoms (b = 0.45, p < .001) and maladaptive cognitive emotion regulation (b = 0.24, p = .048), and trended towards significance with perceived life stress (b = 0.08, p = .052). Frequency of assault history was significantly negatively associated with dyadic adjustment (b = −1.31, p = .003) (see Table 3 for full results).

Table 3.

Results of Regressions Testing Frequency of Sexual Assault Predicting Psychosocial Outcomes Controlling for Alcohol Problems and IPV.

Outcome	Predictors	b	SE	t	p	Confidence Interval
Outcome	Predictors	b	SE	t	p	Lower Bound	Upper Bound
Depression	Intercept	1.57	0.68	2.32	.022	0.23	2.91
	SA frequency	0.44	0.10	4.11	<.001	0.23	0.66
	Alcohol problems	0.18	0.04	4.11	<.001	0.09	0.27
	Psychological IPV	0.04	0.02	2.45	.015	0.01	−0.08
	Physical IPV	−0.02	0.02	−1.25	.214	−0.06	0.01
Perceived stress	Intercept	8.08	0.27	29.91	<.001	7.54	8.61
	SA frequency	0.08	0.04	1.95	.052	−0.00	0.015
	Alcohol problems	0.04	0.01	2.68	.008	0.01	0.07
	Psychological IPV	0.01	0.01	1.41	.161	−0.00	0.02
	Physical IPV	−0.0.1	0.01	−1.41	.256	−0.02	0.00
Maladaptive emotion regulation	Intercept	17.40	0.74	23.32	<.001	15.92	18.87
	SA frequency	0.24	0.12	1.99	.048	0.00	0.48
	Alcohol problems	0.06	0.05	1.32	.190	−0.03	0.16
	Psychological IPV	0.03	0.02	2.00	.047	0.00	0.08
	Physical IPV	−0.35	0.02	−1.81	.072	−0.07	0.00
Dyadic adjustment	Intercept	115.63	3.06	37.68	<.001	109.57	121.68
	SA frequency	−1.31	0.44	−2.99	.003	−2.18	−0.44
	Alcohol problems	−0.24	0.18	−1.37	.172	−0.59	0.11
	Psychological IPV	−0.24	0.07	−3.29	.001	−0.38	−0.10
	Physical IPV	0.15	0.07	2.25	.026	0.02	0.28

Note. Bolded predictors indicate clinical significance. SE = standard error; SA = sexual assault; IPV = intimate partner violence.

Discussion

On the whole, results indicate a significant impact of sexual assault history on psychosocial outcomes in this sample with a dose-response effect of sexual assault exposures across the lifespan. The findings suggest that our first hypothesis, that simply presence or absence of sexual assault history would be related to psychosocial outcomes, was minimally supported. However, our second hypothesis, that the frequency of experience of multiple assaults across childhood, adolescence, and adulthood relates would be significantly related to mood, maladaptive emotion regulation, and perceived relationship adjustment was supported. These findings account for the interdependence of couple members, as well as the presence of alcohol use and IPV in the participant’s intimate relationship.

Past research has clearly indicated that mental health is affected by sexual assault (Campbell et al., 2009) but has rarely evaluated this relationship in a real-world context in which participants are coping with multiple stressors such as IPV and alcohol use, which function both as a cause and effect of trauma exposure. The findings of the current study are of particular importance as they illuminate the high-impact nature of sexual assault history even in the midst of a potentially high-stress context that includes additional experiences of violence and maladaptive emotion regulation strategies. The current sample is experiencing both current relationship stress and shows a significant history of sexual victimization—even accounting for other current stressors, this history of sexual assault stands out in relation to participants’ daily functioning.

With regard to mental health functioning, results do suggest that maladaptive emotion regulation strategies are affected by sexual assault history, which indicates that current feelings about oneself and coping strategies such as substance use are related to history of assault in a high-risk adult community sample. Assault history was associated with mental health outcomes across the board—while most past research has focused on posttraumatic stress (Dworkin et al., 2017), this study shows that stress, as well as depression and emotion regulation, are each affected by assault. Past research has shown that each of these mental health factors is a risk factor for future victimization (Decker & Littleton, 2018), thus addressing mental health, emotion regulation, and substance use for sexual assault victims, inclusive of both childhood and adult experiences, is of paramount importance.

With regard to intimate relationship functioning, past research is limited and findings are mixed (Vitek & Yeater, 2021). This study offered a unique opportunity to examine the impact of sexual assault on either partner’s perceived relationship outcomes in couples whose relationships had experienced at least some physical or psychological violence in the recent past. For the impact of sexual assault frequency to relate to relationship adjustment above and beyond alcohol use and IPV in this sample is notable. This finding shows that sexual assault history is a unique predictor of relationship distress and, thus, that assault history should be more regularly assessed for and addressed in both individual and couples’ treatments.

When considering these results in the larger context of research on sexual assault, several important implications emerge. First, in this sample of 200 people, 71, or about 35% total, endorsed a sexual assault history. The proportion of assault history by gender indicates that about 50% of the women in the sample and 15% of the men have experienced sexual assault. These numbers are high relative to community and college norms, particularly for women (Black et al., 2011; Fisher et al., 2000), which again underscores the importance of examining sexual assault history in more complex real-world situations. The findings are also notable in that they confirm past research suggesting that multiple traumas appear to have an additive effect and indicate that only examining adult or childhood assault likely misses an important piece of the psychosocial puzzle.

Clinically speaking, the findings indicate that as a field, we should be more attentive to cumulative sexual assault history as the effects appear to be significant and ongoing. Although we certainly have had a sense of the damaging impact of sexual assault, seeing this negative psychosocial impact, inclusive of childhood and adult assault, and in a population of adults who have other competing concerns shows just how essential adequate assessment and treatment of the sequelae of sexual violence really is. Our work with assault victims should focus on empowerment and recovery in the service of improving mental health outcomes and, consequently, risk for sexual revictimization and victimization from other types of assault and abuse. Particularly, given the known and multifaceted relationships between violence, mental health, and substance use, it is essential to help victims manage and regain mental health and use adaptive coping strategies going forward. It is also all the more important to screen for and address the impact of sexual assault on those in or at risk for violent relationships to prevent and protect against future violence.

The current study is limited in several ways. First, data collection was cross-sectional, self-report and retrospective, and in a primary heterosexual and Caucasian sample. Based on the findings of this study, we encourage further research around the impact of sexual assault in intimate relationships in diverse populations and also encourage further work that focuses on the additive impact of multiple victimizations across the lifespan. In particular, a larger study that would allow for further analysis of indirect and partner effects would be beneficial to understanding the full impact of sexual assault in the long term. The current study is also limited in that participants with the most severe experiences of recent violence were excluded from the study, which limits variability. The study also has some limitations in measurement. The study uses the Conflict Tactics Scale-2 (Straus et al., 1996) in a sample with both heterosexual and LGBTQ couples, although the CTS-2 as written, was not normed in LGBTQ samples. The study used the TLEQ (Kubany et al., 2000), which allowed us to note presence and frequency of sexual assault events but did not address the severity or perceived impact of each event.

It is both a strength and a limitation of this study that the sample was not intentionally collected with a focus on sexual assault as an outcome. On one hand, this is a limitation in that the many factors at play in the relationships of those who participated may complicate the picture presented by these results. On the other hand, though, drawing from a community sample that includes relationships in which many of the issues that relate to sexual violence are immediately relevant is also a more realistic picture of the lives of many sexual assault victims. In essence, what we have lost with regard to control in the study, we have gained in terms of capturing the complicated real-world experience of those under study. Additional research addressing the long-term implications of sexual assault across the lifespan is an essential for supporting individual mental health and intimate relationship outcomes.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This manuscript is the result of work supported, in part, by the National Institute on Alcohol Abuse and Alcoholism (K23AA023845) and the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment.

ORCID iDs

C. J. Eubanks Fleming

Julianne C. Flanagan

Author Biographies

C. J. Eubanks Fleming, PhD, is an Associate Professor of Psychology at Elon University. Her current research areas include couples and relationship issues, treatment engagement and help-seeking behavior for mental health concerns, and understanding risks for and effects of specific psychological conditions such as posttraumatic stress disorder and substance use disorder.

Sarah T. Giff, PhD, is an Advanced Fellow with the Southeast Mental Illness Research Education and Clinical Center at the Ralph H. Johnson VA Medical Center and the Medical University of South Carolina. Her research focuses on how trauma and substance use relate to couple, family, and social support processes and how including family and social support can enhance interventions.

Shannon R. Forkus, PhD, is a postdoctoral fellow at the Medical University of South Carolina. Her current research focuses on examining mechanisms involved in the development, maintenance, co-occurrence, and treatment of posttraumatic stress disorder and alcohol use disorders among trauma-exposed populations.

Julianne C. Flanagan, PhD, is Associate Professor at the Medical University of South Carolina and a Staff Psychologist at the Ralph H. Johnson VAHCS. Her program of research focuses on examining the behavioral and neurobiological mechanisms linking substance use and PTSD with intimate partner violence and developing novel treatments for individuals and couples.

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