Rape Disclosure and Depression Among Community Women: The Mediating Roles of Shame and Experiential Avoidance

Abstract

Many women who disclose a rape encounter victim-blaming responses, which are associated with negative outcomes. The present study examined rape-related shame and experiential avoidance as mediators of the relation between victim-blaming responses to rape disclosure and depression among 103 rape survivors drawn from a community sample. Results revealed that victim-blaming responses were positively associated with depressive symptoms through rape-related shame and experiential avoidance, and shame was indirectly related to depression via avoidance. Findings suggest clinical interventions should focus on rape-related shame and experiential avoidance in targeting depression among rape survivors, and future research should continue to examine how victim-blaming responses to rape disclosure may be related to these factors.

Keywords

blame shame depression disclosure rape experiential avoidance victim blaming

Researchers estimate that 25-75% of sexual assault victims who disclose their assault receive nonsupportive reactions from at least one person (Campbell, Wasco, Ahrens, Sefl, & Barnes, 2001; Filipas & Ullman, 2001). Nonsupportive reactions to rape disclosure may include holding the victim responsible for the assault or suggesting the victim was to blame (e.g., “You should have been more careful”). Among women who disclose rape experiences, victim-blaming responses are generally experienced as hurtful (Ahrens, Cabral, & Abeling, 2009) and are related to increased self-blame, decreased sexual assertiveness, social withdrawal (Relyea & Ullman, 2015), and depression (Littleton, 2010; Orchowski, 2009). With regard to the latter, a recent study found a significant association between depressive symptoms and receiving blaming responses to the first disclosure of sexual assault among college-aged women (Nikulina, Bautista, & Brown, 2016). Similarly, research on adult female sexual assault victims has demonstrated a positive association between negative reactions to disclosure and depressive symptoms (Hakimi, Bryant-Davis, Ullman, & Gobin, 2018). Accordingly, receiving victim-blaming reactions to disclosure has been labeled “secondary victimization” or “second assault” (Campbell, 1998; Martin & Powell, 1994). Given the negative outcomes associated with victim-blaming responses to rape disclosure, research is needed to examine factors that may account for this association. Two potentially relevant factors are rape-related shame and experiential avoidance.

Rape Disclosure

Anywhere from 65-92% of sexual assault victims disclose their assault to at least one person (Ahrens, Campbell, Ternier-Thames, Wasco, & Sefl, 2007; Fisher, Daigle, Cullen, & Turner, 2003) and often disclose to more (Filipas & Ullman, 2001). The response of the first recipient of disclosure may have the most significant impact on the long-term adjustment of rape victims. Research on the disclosure of concealable stigmatized identities (e.g., mental illness, history of sexual assault, sexual orientation) has shown that receiving a positive response to the first disclosure influences well-being years later by increasing trust and comfort with others regarding the stigmatized identity (Chaudoir & Quinn, 2010). Conversely, negative responses to the initial attempts of disclosure have been found to decrease the likelihood of subsequent disclosures to others (Ahrens, 2006).

Shame, Sexual Assault, and Disclosure

Feelings of shame may influence whether sexual assault victims choose to disclose the assault (Hershkowitz, Lanes, & Lamb, 2007). Brown (2006) defines shame as “an intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging” (p. 45). Sexual assault often invokes a feeling of shame that may persist for a long period following the assault (Amstadter & Vernon, 2008; Feiring, 2005). Specifically, the cultural prejudice and victim-blaming attitudes often faced by victims of sexual assault (Moor & Farchi, 2011) are thought to contribute to rape-related stigma and result in feelings of “badness and shame” (Finkelhor & Browne, 1985, p. 532). Vidal and Petrak (2007) reported that 75% of adult sexual assault victims endorsed feeling shame about themselves following an assault, and there is evidence to suggest that shame is more pronounced for victims of sexual assault compared with victims of other types of trauma (Amstadter & Vernon, 2008). Furthermore, there is some evidence that assault disclosure and responses to such disclosure may exacerbate shame among sexual assault victims (e.g., Ullman, 2003). Specifically, although supportive responses to rape disclosure may buffer feelings of shame (Feiring, Taska, & Lewis, 1996), nonsupportive or blaming responses are associated with increased shame (Ullman, 2003). Research suggests that early experiences of shame following disclosure of sexual abuse predict greater shame 6 years later (Feiring, 2005). Moreover, Ahrens (2006) found that negative social reactions to disclosure led to feelings of shame and embarrassment among rape victims, which decreased the likelihood of future disclosure. In fact, a substantial proportion of sexual assault victims report regretting disclosure due to the blaming responses they received (Jacques-Tiura, Tkatch, Abbey, & Wegner, 2010).

Shame and Depression

Among survivors of sexual assault, shame is positively correlated with negative outcomes, including symptoms of depression (Andrews, Brewin, Rose, & Kirk, 2000; Wilson, 2006). Depressive symptoms are common following experiences of rape, with research suggesting that 13-51% of rape victims endorse depressive symptoms in the aftermath of rape (Campbell, Dworkin, & Cabral, 2009), and women who experience rape are 3 to 5 times more likely to meet lifetime criteria for a major depressive episode than women who have not experienced any crime (Zinzow, Resnick, Amstadter, et al., 2010; Zinzow, Resnick, McCauley, et al., 2012). Notably, preliminary evidence suggests that the elevation in depressive symptoms among rape victims may be driven, at least in part, by rape-related shame. Specifically, a recent study of college women with a history of sexual assault found that assault-related shame mediated the relation between negative reactions to assault disclosure and psychological distress, including depression (DeCou, Cole, Lynch, Wong, & Matthews, 2017). Factors underlying the relation between rape-related shame and depressive symptoms have not yet been identified. However, rape-related shame may motivate withdrawal or a desire to avoid individuals or situations related to rape, which may be relevant in the development or maintenance of depression.

The Relevance of Experiential Avoidance

One factor that may underlie the relation between rape-related shame and depressive symptoms is experiential avoidance, which is defined as the unwillingness to remain in contact with, and efforts to avoid, unwanted internal experiences (Hayes et al., 2004). Due to its aversive nature, shame often motivates individuals to engage in avoidance behaviors to hide their perceived flawed self (Barrett, Zahn-Waxler, & Cole, 1993; Tangney, 1995). Consistent with this, Gibson and Leitenberg (2001) found that feelings of shame mediated the relation between sexual revictimization and avoidant coping strategies. Notably, not only does research indicate a strong relation between sexual assault and experiential avoidance (Batten, Follette, & Aban, 2001; Tull & Roemer, 2003), but also experiential avoidance explains the relation between sexual assault and depression (Merwin, Rosenthal, & Coffey, 2008; Rosenthal, Hall, Palm, Batten, & Follette, 2005; Tull, Gratz, Salters, & Roemer, 2004). Moreover, and of particular relevance to the present study, preliminary evidence suggests that experiential avoidance explains the relation between shame related to traumatic memories and depressive symptoms (Carvalho, Dinis, Pinto-Gouveia, & Estanqueiro, 2015). Thus, there is evidence that the relation between trauma-related shame and depression may be related to heightened experiential avoidance, but it is not yet clear whether shame motivates such avoidance, and whether these relations hold specifically for rape victims.

Study Purpose

Given the aforementioned research and theory, the aim of this study was to examine the roles of rape-related shame and experiential avoidance in the relation between victim-blaming disclosure responses and depressive symptoms. Specifically, we sought to test a serial mediation model in which victim-blaming disclosure responses relate to depression indirectly through increased shame and experiential avoidance. We hypothesized that the relation between victim-blaming responses to rape disclosure and depressive symptoms would be indirect, and explained by rape-related shame and experiential avoidance.

Method

Participants

The initial sample consisted of 491 community women participating in a multisite study examining mechanisms underlying sexual revictimization. One third (32.79%, n = 161) of the total sample reported experiences of rape after the age of 18. Of these rape victims, 64% (n = 103) reported having disclosed the rape to at least one person and, thus, were included in our final sample. These 103 participants ranged in age from 18-25 years (M = 22.30 years, SD = 2.05 years). The majority self-identified as White (77.7%), with one fifth identifying as African American (22.3%) and the rest identifying as Latina (8.7%), American Indian (1.9%), Asian (1.9%), or another racial/ethnic background (1%). The sample was comprised of almost an equal number of students and nonstudents (45.6% nonstudents, 42.7% full-time students, and 11.7% part-time students), with just more than half of the participants (53.4%) reporting some education beyond high school.

Procedures

Young adult women were recruited to participate in the study if they lived in one of four locations (Lincoln and Omaha, Nebraska; Jackson, Mississippi; Oxford, Ohio). Specifically, women between the ages 18 and 25 residing within the specified geographic regions (as identified by a survey sampling company, Survey Sampling International) were mailed a letter notifying them of the study. Additional recruitment methods included advertisements in newspapers and Craigslist, flyers posted throughout the community, and university mass emails. Prior to participation, prospective participants were provided with a description and overview of the study, and were screened for a history of sexual violence across the life span (although all interested participants were eligible if age restrictions were met). Participants completed a series of self-report surveys administered on a computer in the laboratory, as well as diagnostic interviews and laboratory tasks unrelated to the current study. Participants were compensated US$75 for the visit to the laboratory, which lasted approximately 4 hr.

Measures

Rape and related variables

The modified Sexual Experiences Survey (SES; Messman-Moore & Long, 2000; Messman-Moore et al., 2010), an expanded version of the SES (Koss & Gidycz, 1985), was used to assess adult sexual assault and rape after age 18. The measure includes a series of yes/no questions assessing specific types of attempted and completed unwanted sexual activities (ranging from kissing to fondling to penetration). For each unwanted activity, follow-up questions assessed the frequency and methods of coercion involved. Four methods of coercion were assessed for each act: verbal coercion and pressure, misuse of authority, inability to consent due to alcohol or drug intoxication or impairment, and force or threats of force. Rape was defined as completed oral–genital contact or vaginal/anal penetration due to the inability to consent because of substance impairment (alcohol or drugs) or due to the use (or threats of use) of physical force.

If a participant affirmatively answered any question indicating unwanted penetration (oral, vaginal, or anal) due to any method of coercion, she was directed to answer additional follow-up questions about her most distressing victimization experience. Additional details pertaining to the context of the most distressing unwanted sexual experience were assessed, including type of unwanted sexual act(s), method of coercion used (e.g., force, threats of force), identity of the perpetrator (e.g., acquaintance, romantic partner), time since assault, and level of intoxication/impairment of the victim. This information was utilized to identify experiences of rape consistent with the definition above, which included completed oral–genital contact or vaginal/anal penetration due to the inability to consent because of alcohol- or drug-related impairment or due to force (or threats of force).

Responses to rape disclosure

Questions assessing disclosure and related responses were asked in relation to the most distressing victimization experience. Specifically, participants were asked whether they told anybody about the unwanted sexual activity and, if so, when disclosure first occurred, the identity of the recipient of first disclosure, and the response received from that individual. Four items were used to assess positive responses (i.e., recipient was warm and supportive, recipient was sympathetic, recipient believed you, or recipient encouraged you to talk about it). Two items were used to assess victim-blaming responses (i.e., the recipient blamed you and the recipient said you were not careful). Victim-blaming responses to rape disclosure were coded dichotomously (no = nonblaming response, yes = blaming response) if the respondent experienced any blaming response.

Rape-related shame

Participants were asked to indicate the degree to which they currently experienced several different emotions, including shame, in relation to the unwanted sexual experience. The intensity of emotion was rated on a 5-point Likert-type scale ranging from 1 (very slightly/not at all) to 5 (extremely).

Experiential avoidance

Experiential avoidance was assessed with the nine-item Acceptance and Action Questionnaire (AAQ; Hayes et al., 2004). Example items include “I’m not afraid of my feelings” (reverse scored) and “Anxiety is bad.” Participants rate the degree to which each statement applies to them on a 7-point Likert-type scale ranging from 1 (never true) to 7 (always true). The AAQ demonstrates good concurrent validity with relevant constructs such as thought suppression and mental health symptoms (Hayes et al., 2004). Internal consistency in the current study was .62, which although lower than desirable is consistent with other college samples (Bjornsson et al., 2010; α = .64) as well as a sample of interpersonal violence victims (Palm & Follette, 2011; α = .67), and is higher than has been reported in clinical samples (Manos et al., 2010; α = .58).

Depressive symptoms

The Depression Anxiety Stress Scales–21 (DASS-21; Lovibond & Lovibond, 1995a) was used to assess the severity of depressive symptoms. The DASS-21 is a 21-item self-report questionnaire designed to differentiate between core symptoms of depression, anxiety, and stress. Participants rate the extent to which each item applies to them on a 4-point Likert-type scale (0 = never, 3 = almost always). The DASS-21 demonstrates adequate test–retest reliability and good construct and discriminant validity (Lovibond & Lovibond, 1995b). For the present study, only the seven-item Depression subscale was used. Internal consistency in the current study was .88.

Data Analysis Plan

The aim of this study was to test a serial mediation model in which victim-blaming disclosure responses relate to depression indirectly through increased shame and experiential avoidance. Consistent with current recommendations (e.g., Hayes, 2013), we tested the hypothesized indirect effect of shame and experiential avoidance, instead of focusing on individual pathways. Specifically, we tested the overall indirect effect (response to disclosure → current shame → experiential avoidance → depression) using Model 6 of the PROCESS macro v2.15 for SPSS, which uses bootstrapping techniques to construct bias-corrected confidence intervals (CIs) around the indirect effects (Hayes, 2013). The PROCESS macro also provides information regarding the strength of the indirect relations of disclosure responses to depressive symptoms through only current shame (response to disclosure → current shame → depression) and only experiential avoidance (response to disclosure → experiential avoidance → depression).

Results

Of the sample of 103 women who reported disclosing their rape to someone, 27 participants (26.2%) received a blaming response (i.e., were blamed for what happened and/or were told that they were not careful), although most of these participants (77.8%, n = 21) also reported receiving positive responses (i.e., recipient was warm and supportive, recipient was sympathetic, recipient believed you, or recipient encouraged you to talk about it). Thus, 21 participants reported receiving mixed responses. In addition, 88 participants (85.4%) received a positive response. A majority of participants (n = 61, 59.2%) reported disclosing within a week of the assault. Most women reported the first disclosure was to a friend (n = 76, 73.8%), or a dating partner or spouse (n = 10, 9.7%). More than half of the perpetrators (n = 54, 52.4%) were known to participants in a romantic context (e.g., current or past romantic partner, casual date, known or new hook-up) and 24.3% of perpetrators (n = 25) were known to participants in a nonromantic context (e.g., friend, classmate, coworker, boss). One third (n = 35, 34%) of the women reported the perpetrator used threats or physical force (or a weapon) during the rape, whereas 46.6% (n = 48) reported substance-related coercion, and 19.4% (n = 20) indicated the presence of both force and substance-related coercion during the rape.

Rape characteristics and subsequent disclosure (i.e., time since rape, timing of disclosure, identity of perpetrator, and identity of recipient of disclosure) were not associated with current rape-related shame, experiential avoidance, or depression symptoms. Similarly, demographic characteristics were not associated with any of the mediator or outcome variables. Bivariate correlations revealed significant correlations among all primary variables of interest, except for the relation between blaming responses and depressive symptoms (r = .19, p = .051; see Table 1). More than half of the participants (n = 57, 55.3%) reported elevated symptoms of depression on the DASS-21 (i.e., scores ⩾ 10, indicative of at least mild depression; Lovibond & Lovibond, 1995a). Furthermore, comparison of depressive symptoms endorsed by participants who received a purely blaming response to disclosure and those endorsed by participants who received a mixed response revealed no significant differences, t(25) = 1.97, p = .06.

Table 1.

Descriptive Statistics and Bivariate Correlations.

Variable	2	3	4	M (SD) or %	Range
1. Victim-blaming responses	.29**	.25*	.19^†	26.2%	—
2. Current rape-related shame	—	.45**	.31**	3.03 (1.56)	1-5
3. Experiential avoidance		—	.51**	36.71 (6.88)	20-50
4. Depressive symptoms			—	11.83 (9.99)	0-36

†

p = .051. *p < .05. **p < .01.

Mediation Analyses

A serial mediation model was tested with both current feelings of shame about the rape and experiential avoidance serving as mediators of the relation between victim-blaming responses to disclosure and depressive symptoms (see Figure 1). The overall model accounted for 26.7% of the variance in depressive symptoms, F(3, 99) = 12.02, p < .001. The overall serial mediation model, estimated with 10,000 bootstrap samples, was supported, as the CI around the indirect effect did not contain zero (b = 1.20, SE = 0.51, 95% CI = [0.48, 2.60]). This suggests that receiving a victim-blaming response to disclosure of rape relates to higher levels of current shame about the rape, which, in turn, relates to greater experiential avoidance and, subsequently, higher levels of depressive symptoms. Notably, neither the total effect of receiving a victim-blaming response to rape disclosure on depressive symptoms (path c: b = 4.35, SE = 2.21, 95% CI = [−0.02, 8.73]), nor its direct effect (i.e., the remainder of the relation not accounted for by the indirect effect; path c’: b = 1.23, SE = 2.05, 95% CI = [−2.84, 5.30]) was significant. Furthermore, neither of the specific indirect effects of receiving a blaming response to rape disclosure on depressive symptoms through current feelings of shame only (b = 0.60, SE = 0.71, 95% CI = [−0.58, 2.34]), nor experiential avoidance only (b = 1.33, SE = 1.00, 95% CI = [−0.45, 3.52]) was significant.

Figure 1.

Serial mediation model examining the relation of victim-blaming responses to rape disclosure to depressive symptoms through current shame and experiential avoidance.

Although not part of the primary focus of this study, given the high prevalence of positive responses to disclosure, we conducted additional post hoc tests to clarify the unique role of victim blaming (either within the context of positive responses, or controlling for positive responses) in relation to depressive symptoms. To do this, we analyzed data without the six participants who received a purely blaming response to disclosure; results did not change. Similarly, in a separate analysis controlling for positive responses, the pattern of results did not change.

Discussion

The current study examined the role of current rape-related shame and experiential avoidance in the relation between victim-blaming disclosure responses and depression symptoms. Consistent with our hypotheses and previous literature (Ullman, 2003), victim-blaming responses to rape disclosure were indirectly related to depression through elevated rape-related shame and greater experiential avoidance. Although suggested by prior theory and empirical literature (DeCou et al., 2017; Tangney, 1995), this indirect pathway through rape-related shame and experiential avoidance has not been examined previously. The current findings appear to be the first to suggest that both rape-related shame and experiential avoidance are significant factors in understanding responses following negative rape-related disclosure experiences. Specifically, findings support a serial process by which rape-related shame relates to increased experiential avoidance, which, in turn, relates to greater symptoms of depression among rape victims. Although previous literature has demonstrated a positive relation between victim-blaming responses and depression (Littleton, 2010; Orchowski, 2009), the results of this study did not reveal a significant direct relation between victim-blaming responses and depressive symptoms. Rather, victim blaming was indirectly associated with depression through its associations with increases in rape-related shame and experiential avoidance. However, the relation between victim-blaming response and depressive symptoms did show a trend toward significance (p = .051). Replication of these findings are warranted, given the trend may have resulted from low statistical power due to the sample size.

In previous research, assault-related shame mediated the relation between negative responses to assault disclosure and depression in a college sample of female sexual assault victims (DeCou et al., 2017). The present study extends these findings by examining a diverse sample of community women with a history of completed rape (vs. sexual assault), and exploring the role of experiential avoidance in the relation between rape-related shame and depressive symptoms. In the present study, results revealed a significant bivariate relation between rape-related shame and depression, although this relation became nonsignificant when experiential avoidance was included in the larger model. These findings suggest that it is not shame itself that leads to depressive symptoms following victim-blaming responses to rape disclosure, but rather the heightened tendency to avoid negative internal experiences associated with shame. Such an interpretation is consistent with earlier research suggesting that the aversive nature of shame may motivate individuals to hide their flawed self via avoidance coping (Tangney, 1995), and that the tendency to avoid unwanted emotions may, paradoxically, increase emotional distress and suffering (Hayes et al., 2004). However, in contrast to the findings of DeCou et al. (2017), our results suggest that rape-related shame may not inevitably lead to depressive symptoms if survivors are able to effectively approach and process their experience of shame.

Our findings are also consistent with prior literature suggesting that feelings of shame may persist following a sexual assault (Feiring, 2005; Vidal & Petrak, 2007). Past research indicates that a constellation of negative reactions by third parties to assault disclosure (including being treated differently, attempts at distraction, and victim blaming) may exacerbate feelings of assault-related shame (DeCou et al., 2017). The present study extended this research by focusing specifically on victim blaming (the most common negative response to assault disclosure; Ahrens, 2006; DeCou et al., 2017), and providing initial evidence of a relation between victim-blaming responses and current rape-related shame.

One additional finding that warrants discussion is the co-occurrence of both victim-blaming and positive/supportive responses to rape disclosures in this study. Although a minority of rape victims (26%) received a victim-blaming response, the majority of such women (77.8%) reported that victim-blaming responses to rape disclosure were also accompanied by positive, supportive responses. Yet, although most women also reported receiving positive and supportive responses, participants whose disclosures were met with blaming responses endorsed elevated levels of depressive symptoms. Moreover, post hoc tests indicate that positive responses to disclosure do not mitigate the impact of victim-blaming responses, suggesting that victim-blaming responses to rape disclosure are associated with deleterious effects even if offered in a generally supportive context. These results add to past research linking victim-blaming disclosure responses to negative outcomes (Littleton, 2010; Orchowski, 2009; Ullman & Peter-Hagene, 2014, 2016), by suggesting that positive, supportive responses to rape disclosure may not buffer the detrimental impact of negative responses. Previous research examining relations betweeen positive responses to rape disclosure and negative outcomes is inconsistent, with some studies showing a buffering effect (Ullman, 2000) and others finding no association (Orchowski & Gidycz, 2015; Ullman & Peter-Hagene, 2014, 2016). However, less is known about outcomes associated with mixed (positive and negative) responses to rape disclosure. Indeed, our data may indicate that the typical response to rape disclosure is a mixed response (i.e., both blaming and supportive). However, given the small sample here, we must be cautious with such an interpretation. Future research with larger samples is needed to explore possible differential effects of receiving a purely positive versus mixed response to assault disclosure.

Study Strengths, Limitations, and Future Directions

The current study examined the potential impact of negative reactions to rape disclosure on emotional responding and depressive symptoms. Although earlier studies have examined aspects of our model (e.g., Batten et al., 2001; Carvalho et al., 2015; DeCou et al., 2017; Jacques-Tiura et al., 2010), none has examined how rape-related shame and experiential avoidance may sequentially account for depressive symptoms associated with blaming responses to rape disclosure. Furthermore, earlier studies have largely relied on college student samples (e.g., DeCou et al., 2017). The strength of the current findings is bolstered by our use of a community sample of young adult women. Nonetheless, the current sample size precluded examination of the impact of race, ethnicity, and other demographic factors on the relations of interest. Given past research suggesting that negative reactions to rape disclosure may be influenced by the race, class, or gender of the victim (Ahrens, 2006), future studies are needed to explore the moderating role of these variables in the relations of interest. Furthermore, the nonsignificant association (p = .051) between victim-blaming responses to rape disclosure and depressive symptoms may be the result of a lack of power due to the final sample size. Future studies with larger samples should examine interrelations among victim-blaming responses, rape-related shame, experiential avoidance, and depressive symptoms among rape victims.

Previous research examining assault-related shame and negative responses to assault disclosure assessed a variety of negative responses from multiple disclosure recipients (DeCou et al., 2017). In contrast, the current study focused on responses to the victim’s first disclosure only, given earlier work establishing the critical and influential nature of these initial disclosure responses (Ahrens, 2006). Our findings corroborate earlier work highlighting the importance of initial disclosures and related responses. However, additional research is needed to determine whether subsequent supportive responses may ameliorate the apparently negative impact of nonsupportive responses by the first disclosure recipient.

Although the current study examined factors that may account for the relation of negative responses to rape disclosure to depressive symptoms, the cross-sectional design and retrospective data do not permit conclusions about causality or allow us to establish a temporal sequence among variables. Longitudinal studies would help to establish the prospective relation of victim-blaming responses to disclosure and negative outcomes such as depression. However, even with such designs, it is difficult to assess the complex interrelations and unfolding of emotional responses to rape over time. Ecological momentary assessment and daily diary studies focused on examining the interplay of others’ responses to rape disclosures, rape-related shame, experiential avoidance, and psychiatric symptoms across days, weeks, and months are needed to clarify the relations examined here. Another limitation was the use of a one-item, self-report measure of rape-related shame, responses to which may be influenced by an individual’s current depressive symptoms as well as her ability to identify and accurately report on such experiences. Given that there are currently no psychometrically validated measures of rape-related shame, future research would benefit from the development and use of more comprehensive assessments, including assessing behavioral and cognitive components of shame. In addition, consistent with previous studies utilizing the AAQ (e.g., Palm & Follette, 2011), the internal consistency for this measure was lower than desirable. Nonetheless, the AAQ is a widely used measure that has been useful in predicting a range of outcomes (e.g., depression, anxiety, treatment dropout; Bond et al., 2011).

Implications for Intervention

Our findings add to a growing literature highlighting the significance of how others respond to disclosures of rape by survivors, as well as the ways in which those responses may influence the self-perceptions and emotional responses of the survivors themselves. Results highlight the clinical importance of directly assessing and addressing responses to rape disclosure, particularly when those responses are victim blaming or otherwise negative. Similarly, therapists working with survivors of sexual assault should strive to provide a supportive environment for discussion of rape-related shame to effectively facilitate emotional processing and reduce experiential avoidance. Whereas tertiary interventions such as psychotherapy can be helpful in addressing shame among survivors of sexual assault following victim-blaming responses to disclosure, our results also suggest the importance of primary interventions designed to decrease the likelihood of negative, victim-blaming responses in the first place, such as the “Start by Believing” campaign by End Violence Against Women International (startbybelieving.org). The relevance of victim-blaming responses to depressive symptoms among rape victims provides further support for the importance of these public educational campaigns encouraging supportive responses to rape disclosure in reducing the risk of psychopathology following rape.

Conclusion

The current study examined rape-related shame and experiential avoidance in the relation between victim-blaming responses to rape disclosure and depressive symptoms in a community sample of female young adult rape victims. Results indicate that receiving a victim-blaming response to rape disclosure is indirectly associated with depressive symptoms via elevated rape-related shame and, subsequently, greater experiential avoidance. Specifically, shame may motivate individuals to engage in experiential avoidance, which, in turn, may be associated with greater depressive symptoms. Our results highlight the potential clinical utility of directly targeting both shame associated with victim-blaming responses to rape disclosure and related emotion processes such as experiential avoidance among female adult rape victims with depression symptoms.

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by a grant to David DiLillo (principal investigator), Kim L. Gratz (co-investigator), and Terri Messman-Moore (co-investigator) from the National Institute of Child Health and Human Development (R01HD062226). Dr. Messman-Moore would also like to acknowledge support from the O’Toole Family endowed professorship.

Author Biographies

Prachi H. Bhuptani, MA, is a graduate student in Miami University’s clinical psychology program. Her research focuses on the investigation of ecological factors and processes underlying experiences of shame following sexual victimization among women. In addition, her work involves examining the impact of shame on the psychological well-being of sexually victimized women.

Julia S. Kaufman, MA, is a graduate student in the clinical psychology doctorate program at Miami University. Her research interests include the impact of interpersonal violence on mental health and interpersonal functioning. She is particularly interested in the relation between child maltreatment and disruptions in the development of emotion regulation. Previously, her work examined parenting among child maltreatment survivors and the intergenerational continuity of child maltreatment.

Terri L. Messman-Moore, PhD, is the O’Toole Family Professor of Psychology at Miami University. Her research program focuses on three intersecting domains: interpersonal violence (child and adolescent sexual victimization, child maltreatment, adult revictimization), trauma, and emotion dysregulation. She is particularly interested in how early childhood sexual and emotional trauma intersects with emotion dysregulation to impede recovery and result in posttraumatic stress disorder (PTSD), substance use disorders, risky sexual behavior, and complex PTSD in adults. In addition, she is interested in examining the utility of mindfulness, self-compassion, meditation, and yoga practice in the alleviation of traumatic sequelae.

Kim L. Gratz, PhD, is professor and chair of the Department of Psychology at the University of Toledo. She received her PhD in clinical psychology from the University of Massachusetts Boston in 2003, after completing her predoctoral internship at McLean Hospital/Harvard Medical School. She received the Young Investigator’s Award of the National Education Alliance for Borderline Personality Disorder in 2005 and the Mid-Career Investigator Award of the North American Society for the Study of Personality Disorders in 2015. Her laboratory and treatment outcome research focuses on the role of emotion dysregulation in borderline personality disorder, self-injury, and risky behaviors.

David DiLillo, PhD, is Willa Cather professor of Psychology at the University of Nebraska. His research interests lie in the area of interpersonal violence and PTSD, including the role that alcohol plays as a contributor to, and consequence of, trauma. Recent projects of his research team have focused on psychosocial mediators of revictimization, cognitive and emotional contributors to intimate partner violence, and the impact of alcohol intoxication on bystander interventions to prevent sexual assault. He has received multiple awards from NIH to support his research.

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