Physical and Sexual Abuse of Adults

Violence is an important public health concern in the United States. The majority of Americans will fall victim to a violent crime during their lifetime. Besides mortality, violence creates a heavy toll in medical costs, disability, and psychiatric sequelae.

Assault can be viewed in the context of two variables. The first involves who is being assaulted, and the second is where the assault occurs. With these parameters assault can be classified into several categories, the most common being violent crimes (aggravated and simple assault, robbery), rape, domestic violence, workplace violence, and torture. The prevalence of the different types of assaults is most often reported by two different data collection systems: (1) the Federal Bureau of Investigation’s Uniform Crime Report (UCR), which collects reported crime information from local law enforcement agencies and (2) the Bureau of Justice Statistics’ National Crime Victimization Survey (NCVS), which generates estimates of the likelihood of victimization from different types of assaults.

VIOLENT CRIME

Violent crime is defined as murder and nonnegligent manslaughter, forcible rape, robbery, and aggravated assault. These categories exclude simple assault, which is defined as an assault not involving a weapon and in which the victim was not seriously harmed. Simple assault has also been defined as stalking, intimidating, coercing, or hazing.

Prevalence

In 2011, the UCR reported over 1.2 million violent crimes occurred within the United States. Aggravated assault accounted for approximately 750,000 of this total, and robberies accounted for approximately 350,000. Ten-year trends show a decrease of 16 percent in violent crime since 2002. Aggravated assault was the most reported violent crime (62 percent), followed by robbery (29 percent), forcible rape (7 percent), and murder (1 percent). Also in 2011, firearms were found to be used in 21 percent of aggravated assaults and 41 percent of robberies.

Risk Factors

Gender and age play large roles in the rate of risk for assaults of all types. Males between the ages of 15 and 34 years are more likely to be assaulted than females and are 11 times more likely to be assaulted by strangers than by someone they know. Research suggests that race is an important factor as well, with African Americans being at greater risk of violence and having a death rate that is four or five times higher than age-matched whites during aggravated assaults. The NCVS found that males and females in households earning less than $15,000 in annual income were twice as likely to be robbed and 1.5 times as likely to suffer a physical assault. Homelessness has also been shown to be a factor in increased physical assaults. Finally, substance abuse has been shown in multiple studies to increase the risk of victimization.

RAPE

Rape is the forceful coercion of an unwilling victim to engage in a sexual act, usually sexual intercourse, although anal intercourse and fellatio can also be acts of rape. The legal definition of rape varies from state to state. Some states strictly define rape, whereas other states describe any sex crime as varying degrees of sexual misconduct or sexual assault. Rape can occur between married partners and between persons of the same sex. Forced acts of fellatio and anal penetration, although they frequently accompany rape, are legally considered sodomy.

In some states the definition of rape has been changed to substitute the word person for female. In most states, male rape is legally defined as sodomy. Like other violent crimes, sexual assault is declining; however, every 2 minutes someone in the United States is sexually assaulted. Although much of the population believes in the stereotype of the culprit being a stranger, research has shown that only about 26 percent of all rapes are committed by a stranger.

Prevalence

Unfortunately, accurate statistics are difficult to obtain because of underreporting and unacknowledgment. The Rape, Abuse, and Incest National Network (RAINN) estimates that over half of rapes go unreported. Although in the United States, rapes have fallen in number since 1993, currently there is an average of 207,754 rapes and sexual assaults per year. RAINN estimates that 1 in 6 US women and 1 in 33 US men are victims of sexual assault.

In addition to being underreported, there are many rapes that go unacknowledged by the victim, who often refer to the assault in more benign terms such as a misunderstanding, despite the fact that it meets the legal definition of rape. Research has reported that this percentage is substantial; more than 50 percent of sexual assaults may go unacknowledged and, thus, unreported. Research has further revealed that victims who fail to acknowledge having been raped usually believe that rape involves two strangers and greater force, as opposed to the views of those who acknowledge their having been sexually assaulted.

Statistics show that most men who commit rapes are between 25 and 44 years of age; 51 percent are white and tend to rape white victims, 47 percent are black and tend to rape black victims, and the remaining 2 percent come from all other races. Alcohol is involved in 34 percent of all forcible rapes. Homosexual rape is much more frequent among men than among women and occurs frequently in closed institutions such as prisons and maximum security hospitals.

Risk Factors

Although women are usually the victim of rape and sexual assault, greater than 10 percent of victims are estimated to be men. Furthermore, most experts believe that men underreport more than women. Nevertheless, young women have four times the risk of any group of becoming a victim of sexual assault. Persons who are raped can be of any age. Cases have been reported in which the victims were as young as 15 months and as old as 82 years. However, 80 percent of all rape victims are under the age of 30 years and the Bureau of Justice statistics indicate that women age 16 to 24 years are at the greatest risk for rape in the United States. Having been a victim of childhood abuse or previous assault increases the likelihood of further assault of all types. Most rapes are premeditated; about half are committed by strangers and half by men known, to varying degrees, by the victims.

The Violence Against Women Act has had an important role to play in reducing rape and other types of violence (Table 26-1).

Table 26-1
Violence Against Women Act (VAWA)

Perpetrators

In general, rape is considered a crime of power and aggression, not one of sexuality. Male rapist can be categorized into separate groups: sexual sadists, who are aroused by the pain of their victims; exploitive predators, who use their victims as objects for their gratification in an impulsive way; inadequate men, who believe that no woman would voluntarily sleep with them and who are obsessed with fantasies about sex; and men for whom rape is a displaced expression of anger and rage. Seven percent of all rapes are perpetrated by close relatives of the victim; 10 percent of rapes involve more than one attacker.

Rape often accompanies another crime. Rapists always threaten victims, with fists, a knife, or a gun, and frequently harm them in nonsexual ways as well. Victims can be beaten, wounded, and killed.

In cases of male or homosexual rape, the dynamics are identical to those of heterosexual rape. The crime enables the rapist to discharge aggression and to aggrandize himself. The victim is usually smaller than the rapist, is always perceived as passive and unmanly (weaker), and is used as an object. A rapist selecting male victims may be heterosexual, bisexual, or homosexual. The most common act is anal penetration of the victim; the second most common is fellatio.

SEXUAL COERCION

Sexual coercion is a term used for incidents in which a person dominates another by force or compels the other person to perform a sexual act.

STALKING

Stalking is defined as a pattern of harassing or menacing behavior coupled with a threat to do harm. The first antistalking law was passed in 1990 in California. Now most states prohibit stalking, although some will not intervene unless an act of violence has occurred. In states with stalking laws, the person can be arrested on the basis of a pattern of harassment and can be charged with either a misdemeanor or felony. Some stalkers continue the activity for years; others, for only a few months. The court may mandate that stalkers undergo counseling sessions. The best means of deterrent is to report all stalkers to law enforcement agencies. Most stalkers are men, but women who stalk are just as likely as men to attack their victims violently.