The act of murder has profound effects, not just on the individual victim, but also on the friends, family members and acquaintances who are left behind and who are sometimes referred to as the ‘secondary victims.’ The act of murder is shocking in its finality and irrevocability, and the responses of survivors are both qualitatively and quantitatively different from the normal grieving process.^(23,24) Rock⁽²⁵⁾ has suggested that it is not just the death itself, but the manner of death and its social meaning that is so devastating for those who are left behind. Unlike a ‘natural’ death, survivors are unprepared for their loss, there can be no anticipatory mourning, no reconciliation, and no proper leave taking. Many survivors describe feelings of stigmatization, isolation, shame, and betrayal, but feel unable to communicate their distress or to connect emotionally with fellow beings. They often feel marginalized by the criminal justice system, with little access to information and they are burdened with having to cope with the inevitable, legalistic bureaucracy and the practical demands of life during a period of acute distress and emotional turmoil. In cases where the perpetrator and the victim are members of the same family, the survivors may experience particularly intense feelings of guilt and conflicting emotions.

The effects of violent traumatic bereavement on the secondary victims include physical health problems, cognitive impairment, and psychological effects, including posttraumatic stress disorder, depression, phobic avoidance, and impaired work and social functioning.^(26,27) Female gender and losing a child predict worse psychiatric outcome.⁽²⁷⁾ Survivors of homicide, tend to manifest both trauma symptoms and symptoms of grief, phenomena, with either predominating or appearing intermittently.⁽²⁸⁾ This has lead to a proposed new diagnostic category of ‘traumatic grief’, which contains two core components; trauma and of loss.⁽²⁹⁾

The definition of rape varies across countries and between states within countries. In the UK, prior to 1994, the definition of rape was restricted to penile penetration of the vagina, with other forms of non consensual penetrative sex being defined as indecent assault. However, in 1994, the definition of rape was extended to include non consensual anal intercourse, thereby recognizing male rape victims for the first time. The 2003 Sexual Offences Amendment Act further broadened the definition of rape to include penetration of the mouth as well as penetration of the vagina or anus by the penis. It also introduced three new measures on the issue of consent: first, that a person can only consent to sexual relations if they have the freedom and capacity to make that choice, second, that all the circumstances at the time of the offence must be considered in determining whether the defendant is reasonable in believing the complainant consented and third, that individuals will be considered most unlikely to have agreed to sexual activity if they were subject to threats or fear of serious harm, if they were unconscious, drugged or abducted, or if they were unable to communicate because of a physical disability.

In the majority of cases of rape, the perpetrator is known to the victim and in many cases, the rapist is the current or former husband or partner.⁽³⁰⁾ In spite of the seriousness of the offence, the British Crime Survey⁽³⁰⁾ found that only 60 per cent women who had been subjected to rape or serious sexual assault had told anyone about it and only around one in seven cases had been reported to the police. Reasons women gave for not reporting include: fear of reprisals, fear of public identification, fear of appearing in Court and having to give evidence and lack of confidence in the legal system.⁽³¹⁾ There is some evidence suggesting that women who proceed with prosecution following rape do worse, in terms of social adjustment and self esteem at one year follow up than women who decide not to proceed.⁽³²⁾ Whether this is because Court proceedings delay or slow down the process of psychological recovery following rape, or because the legal process and particularly the experience of being cross examined in Court, represents a form of ‘secondary traumatization’, is not entirely clear. If women do proceed with the Criminal Justice process, however,
preparing them for the experience, providing them with appropriate information beforehand and giving them the opportunity to exercise choice, can help to offset the potentially de-stabilizing and distressing impact of criminal proceedings. Ultimately, the attitude taken by the police and the way the victim feels they have been treated appears to be more important in determining their psychological adjustment and satisfaction with the process, than the actual verdict.⁽³²⁾

About one-third of women who report rape develop long term psychological and social problems. These effects tend to be more severe and chronic than following non sexual violence.^(33,34) Rape trauma syndrome was first described in the 1970’s⁽³⁵⁾ and was subsequently superseded by Posttraumatic Stress Disorder. Posttraumatic stress symptoms are generally present in the days and weeks following the assault, but then spontaneously resolve in the majority of cases. For some victims, however, the condition may become chronic and persist for many years, if left untreated.⁽³⁶⁾ Higher rates of depression, suicidal ideation, generalized and phobic anxiety, alcohol and drug dependence and sexual dysfunction as well as physical health problems are also found in rape victims compared with non rape victims.^{(37,38,39,40,41)}. Women who have been raped often describe problems in relationships, with excessive dependence, inability to trust and loss of confidence and self esteem. Similar responses have been described with male victims of sexual assault.⁽⁴²⁾