University of New Hampshire

University of New Hampshire Scholars' Repository

Master's Theses and Capstones Student Scholarship

Fall 2020

THE LONG-TERM EFFECTS OF SEXUAL ASSAULT ON ROMANTIC

Follow this and additional works at: https://scholars.unh.edu/thesis

Recommended Citation
Moschella, Matthew, "THE LONG-TERM EFFECTS OF SEXUAL ASSAULT ON ROMANTIC RELATIONSHIPS:
A QUALITATIVE STUDY" (2020). Master's Theses and Capstones. 1390.
https://scholars.unh.edu/thesis/1390

This Thesis is brought to you for free and open access by the Student Scholarship at University of New Hampshire
Scholars' Repository. It has been accepted for inclusion in Master's Theses and Capstones by an authorized
administrator of University of New Hampshire Scholars' Repository. For more information, please contact
[email protected].
THE LONG-TERM EFFECTS OF SEXUAL ASSAULT ON ROMANTIC RELATIONSHIPS:

A QUALITATIVE STUDY

BY

MATTHEW A. MOSCHELLA

Bachelor of Arts, Stonehill College, 2018

THESIS

Submitted to The University of New Hampshire

in Partial Fulfillment of

the Requirements for the Degree of

Master of Arts

In

Justice Studies

September, 2020
 THESIS COMMITTEE PAGE

This thesis has been examined and approved in partial fulfillment of requirements for the degree

of Master of Arts Justice Studies:

Thesis Chair, Sharyn J. Potter, Professor of Women and Gender Studies,

Donna Perkins, Associate Professor of Justice Studies, University of New

Robert Eckstein, Senior Lecturer of Justice Studies and Psychology,

ii
 DEDICATION

I would like to dedicate this thesis to all those affected by sexual assault and to all those who

work to end sexual violence.

iii
 ACKNOLWEDGMENTS

I would also like to thank my thesis chair, Dr. Sharyn Potter and the members of my thesis

committee, Dr. Donna Perkins and Dr. Robert Eckstein for their valuable feedback upon reading

and reviewing my thesis.

iv
TABLE OF CONTENTS

ABSTRACT........................................................................................................................... vi

CHAPTER PAGE

I. INTRODUCTION ..................................................................................................... 1
Sexual assault and Risk of Revictimization....................................................... 3
Sexual Assault and Sexuality............................................................................. 3
PTSD and Relationship Satisfaction.................................................................. 5
Disclosing a Sexual Assault............................................................................... 6
The Research Project......................................................................................... 8
II. METHOD................................................................................................................... 9

III. RESULTS................................................................................................................... 12
Abusive and Unhealthy Relationships................................................................ 12
Dating Apprehension.......................................................................................... 16
PTSD Symptoms within Dating Relationships................................................... 19
Disclosing to a Partner........................................................................................ 21

IV. DISCUSSION............................................................................................................. 23
Abusive and Unhealthy Relationships................................................................. 23
Dating Apprehension.......................................................................................... 26
PTSD Symptoms within Dating Relationships.................................................... 27
Disclosing to a Partner......................................................................................... 28
Other Findings..................................................................................................... 30
Preliminary Analysis of the Relationship of Post-Sexual Assault Variables..... 31

V. LIMITATIONS........................................................................................................... 34

VI. CONCLUSIONS AND FUTRE DIRECTIONS......................................................... 35

VII. REFERENCES........................................................................................................... 40

v
 ABSTRACT

THE LONG-ERM EFFECTS OF SEXUAL ASSAULT ON ROMANTIC RELATIONSHIPS: A

QUALITATIVE STUDY

by

Matthew A. Moschella

University of New Hampshire, September 2020

Sexual assault has immediate and long-term physical, mental, economic, and social

impacts for survivors (Potter et al., 2018; Kilpatrick et al., 2007; & Sugar et al., 2004). However,

there is only a limited understanding of how sexual assault impacts a survivor’s dating behaviors

and romantic relationships. Therefore, this study identifies survivors’ perceptions on how sexual

assault impacted their romantic relationships. Specifically, it seeks to answer (1) do some

survivors avoid romantic relationships and some engage in risky dating? and (2) what types of

negative responses do survivors receive when they disclose a sexual assault to a romantic

partner? The current study uses Braun and Clarke’s six-phase approach to thematic analysis to

examine qualitative interview data from 32 survivors who were sexually assaulted while in

college. The following themes were identified: abusive and unhealthy relationships, dating

apprehension, post-traumatic stress disorder (PTSD) triggers within intimate relationships, and

disclosure to a partner. Sexual assaults impacted romantic relationships in a variety of ways.

Many participants were fearful of entering a relationship after the sexual assault. Of those who

did enter a relationship, several had altered perceptions of healthy dating behavior and sexuality

or experienced PTSD symptoms within the dating relationship. In some cases, dating led to re-

vi
victimization. When disclosing a sexual assault to a romantic partner, survivors received

negative responses from partners who shamed and belittled the survivor after a sexual assault

disclosure or did not know how to respond.

vii
 INTRODUCTION

Sexual assault perpetrated against college and university students is a public health

problem that directly affects approximately 11 percent of students (Cantor et al., 2015). While all

students are at risk, 20 percent of female and 5 percent of male students report being sexually

assaulted at least once as they pursue an undergraduate degree, and extreme assumptions indicate

that between 5 percent to 80 percent of females and 1 percent to 84 percent of males could

theoretically have this crime committed against them (Rosenberg et al., 2018; & Cantor et. al.,

2015). Sexual assault often occurs within intimate partnerships. According to a national survey,

approximately 18.3 percent of women and 8.2 percent of men are sexually assaulted at some

point during their lifetime by an intimate partner (Smith et al., 2018). Sexual assault is a type of

sexual violence that includes physical transgressions such as rape, attempted rape, unwanted

sexual touching, or forcing the victim to preform sexual acts, but not stalking, or other forms of

harassment (RAINN, 2020). Sexual violence is perpetrated against multiple minority groups (i.e.,

sexual, gender, ethnic, and racial minority groups) at higher rates than majority groups, although

there is limited data that captures campus sexual assault rates in minority populations (Coutler et

al., 2017; & Johnson et al., 2016). The impacts of sexual violence perpetrated against

undergraduate students are immediate. When student choose to stay in school following an

assault, they may be fearful of being in the same room as their attackers, fearful of retaliation by

classmates if they choose to report, and are less likely to feel safe and accepted on campus

(Office of Civil Rights, 2015; Cortina, et al., 1998). Survivors of sexual violence are also less

likely to complete their college degree and are likely to graduate with a lower GPA (Potter et al.,

2018; Mengo & Black, 2016; Jordan et al., 2014).

1
 The short and long-term mental and physical health problems attributed to sexual

violence are well documented in the literature (Kilpatrick et al., 2007; Sugar at al., 2004).

Following an incidence of sexual violence, survivors are at risk of multiple types of physical

injuries (e.g., bruises, cuts, injuries to genitalia, broken bones, head or brain injury, etc.) (Amar

& Gennaro, 2005; & Sugar et al., 2004). Compared to people who have not been sexually

assaulted, survivors are at risk of suffering sexually transmitted infections, chronic health

problems, including chronic pain, and report a significantly lower health-related quality of life

(Schou-Bredal et al., 2020; Amar & Gennaro, 2005; Sugar et al., 2004; Kohn et al., 2000; &

Sadler et al., 2000). Sexual assault survivors are also at risk of severe mental health challenges

including panic attacks, post-traumatic stress disorder (PTSD), anxiety, depression, alcohol or

drug abuse, acute fear, acute stress, non-suicidal self-injury, and suicidal behaviors (Schou-

Bredal et al., 2020; Chang et al., 2019; Gilmore & Flanagan, 2018; Carey at al., 2018; Rosellini

et al., 2017; Kirkner et al., 2017; Kilpatrick et al., 2007; & Ullman et al., 2002).

Less is known about the impact sexual violence perpetrated against college students has

on their romantic relationships after the sexual assault. However, research conducted on post-

assault variables indicate that sexual assault could impact post-assault relationships in some

ways. Research has indicated that an initial sexual assault is a risk factor for subsequent sexual

assaults (Walker et al., 2019), that sexual assaults can affect survivor’s sexuality (O’Callaghan et

al., 2019), that the mental and physical harm done to survivors can have lasting effects on post-

assault relationships, and that disclosing a sexual assault can have either positive or negative

effects on survivor recovery (Ullman & Peter-Hagene, 2014; Ullman et al., 2007; Campbell et

al., 2001). In the literature review that follows, I discuss the existing literature regarding sexual

assaults and post-assault variables that could impact romantic relationships. I review literature on

2
the relationships between sexual assault and revictimization, sexual assault and changes in

sexuality, PTSD and relationship satisfaction, and the effects of disclosing a sexual assault to a

partner.

Sexual Assault and Risk of Revictimization

An initial sexual assault is predictive of further sexual assaults. Extant literature has

indicated that almost half of all childhood sexual abuse survivors are sexually revictimized as

adults (Walker et al., 2019) and that being sexually assaulted as an adult also increases the risk of

further sexual victimizations (Messman-Moore et al., 2013). Incapacitated sexual assault (ISA),

which makes up the majority of rapes on colleges, and sexual assault as a result of intimate

partner violence, which affects between 20 percent and 50 percent of college students, may in

particular increase the likelihood of further victimizations (Nabors, 2010; & Mohler-Kuo et al.,

2004).

Sexual Assault and Sexuality

Sexual intimacy has been a topic of interest for sexual assault researchers (e.g.,

O’Callaghan et al., 2019; & Weaver, 2009). Previous research indicates that sexual assaults alter

the frequency of sexual interactions, either by increasing sexual promiscuity or sexual

reservation (O’Callaghan et al., 2019; Weaver, 2009; Amar & Gennaro, 2005; Sadler et al.,

2000; & Kohn et al., 2000). However, researchers have not examined how this change of

behavior resulting from the sexual assault impacts survivors’ willingness to form relationships

with intimate partners (O’Callaghan et al., 2019; Perillox, Duntley, & Buss, 2011; Weaver, 2009;

& Deliramich & Gray, 2008).

Researchers have attempted to explain why a survivor may have a decreased frequency of

sexual interactions (e.g. O’Callaghan et al., 2019; Turchik & Hassija, 2014; Weaver, 2009; &

3
Deliramich & Gray, 2008). Previous research has attributed the decrease in sexual behavior to

mental health outcomes (e.g., anxiety and intrusive memories related to sexual interactions or no

longer perceiving sex as pleasurable or desirable), social reactions (e.g., stigma regarding sexual

reputation; slut shaming; reduced social life), physical pain or sexually transmitted infections

(STIs) resulting from the assault, and pre-existing personality traits such as low negative urgency

(i.e., the tendency to act not rashly when distressed) (Combes et al., 2014; Turchik & Hassija,

2014; Weaver, 2009; Amar & Gennaro, 2005; Sadler et al., 2000; & Van Berlo & Ensink, 2000).

Researchers have also attempted to explain why some survivors increase sexual behavior

and suggest that increased sexual behavior could be a result of coping with trauma (Viallancourt-

Morel et al., 2016; & Aaron, 2012). O’Callaghan and her colleagues (2019) suggest that shame,

the desire to feel in control of their recovery, the wish to feel loved, and the lack of experience

with respectful and communicative partners all attribute to increased sexual behavior

(O’Callaghan et al., 2019). Others have attributed increased sexual activity to be the result of

another coping strategy, drug use, which is also associated with increased sexual activity

(Deliramich & Gray, 2008).

Alcohol and drug use have been indicated to be an important pre- and post-assault

variable because sexual assault increases the risk of alcohol and other drug use and because

alcohol and other drug use increase the risk of sexual assault (Deliramich & Gray, 2008; &

Abbey et al., 2004). Some researchers have shown that the relationship between non-

interpersonal trauma and drug use is fully mediated by PTSD symptoms, although interpersonal

trauma and drug use is only partially mediated by PTSD symptoms (Ullman et al., 2013; Wu et

al., 2010). The relationship between drinking, drug use, and increased or decreased sexuality has

been shown to be partly mediated by predisposing personality traits (Combs et al., 2014). Combs

4
and her colleagues (2014) found that of sexual assault survivors, those who had high negative

urgency (i.e., the tendency to act rashly when distressed) were more likely to have drinking

problems and use drugs, both of which are variables that can lead to increased sexual behavior

and an increased likelihood of sexual assault (Combes et al., 2014 & Abbey et al., 2004).

Increased alcohol and drug use, as a coping response for previous sexual trauma, may increase

sexual activity in unsafe situations (Deliramich & Gray, 2008), thereby increasing the risk of

sexual assault (Mohler-Kuo et al., 2004), which can lead to more PTSD symptoms and further

drug use (Deliramich & Gray, 2008).

PTSD and Relationship Satisfaction

Another area of post-assault research has focused on PTSD and relationships (DiMauro

& Renshaw, 2019; & Lambert et al., 2012). PTSD may lead to sexual problems such as sexual

disfunction (Letica-Crepulja et al., 2019), avoidance behaviors that could result in a lack of

communication (Al-Turkait & Ohaeri., 2008), and an increase of aggression and hostility

(Watkins et al., 2011). Sexual disfunction, lack of communication, and hostility could all lead to

relationship stress and dissatisfaction (DiMauro & Renshaw, 2019).

Sexual disfunction and relationship conflict, that may result from a lack of

communication or increased hostility, are related variables that impact relationship satisfaction

(DiMauro & Renshaw, 2019; & Metz & Epstein, 2002). The relationship between sexual

problems and relationship satisfaction is bidirectional; not only do sexual problems lead to

relationship dissatisfaction, but relationship dissatisfaction leads to sexual problems (Metz &

Epstein, 2002; & Byers, 2001). Furthermore, poor communication is associated with relationship

distress, as well as sexual disfunction and hostility (Metz & Epstein, 2002). Post-Traumatic

Stress Disorder may amplify all of these variables that lead to relationship dissatisfaction as

5
those with PTSD have been shown to avoid communication, act more aggressively, or have

sexual problems such as sexual disfunction (DiMauro & Renshaw, 2019; Letica-Crepulja et al.,

2019; Watkins et al., 2011; & Al-Turkait & Ohaeri., 2008). Another reason survivors may avoid

healthy communication is because sharing information about a sexual assault can put survivors at

risk of hurtful responses (Relyea & Ullman, 2015; Ullman & Peter-Hagene, 2014; Ahrens et al.,

2009; & Campbell et al., 2001).

Disclosing a Sexual Assault

A fourth area post-assault research has focused on is disclosing a sexual assault to a

romantic partner (O’Callaghan et al., 2019; Ullman, 2011, Ahrens et al., 2009; Ahrens et al.,

2007; & Fisher et al., 2003). Previous research indicates that responses to a sexual assault

disclosure can be hurtful, helpful, or neutral and that when sexual assaults are disclosed, they are

most often disclosed to informal, rather than formal support resources (i.e., friends, family, and

romantic partners rather than police or other authorities) (Hakimi et al., 2018; Ahrens et al.,

2009; Ahrens et al., 2007; & Fisher et al., 2003). The responses to a sexual assault disclosure,

whether they be by informal or formal support, can impact survivor’s PTSD symptoms and

overall recovery (Ullman & Peter-Hagene, 2014; Ullman et al., 2007; Campbell et al., 2001).

Ullman and Peter-Hagene (2014) found that negative social reactions to assault disclosure, such

as reactions of control, blame, and treating the survivor differently, are correlated with

maladaptive coping strategies, such as avoidant coping, that negatively affect the survivor’s

recovery from PTSD and can increase PTSD symptomatology (Ullman & Peter-Hagene, 2014).

Survivors who receive negative reactions may also have increased shame or feelings of

helplessness, or decreased trust in others (Ullman & Peter-Hagene, 2014). Although some

researchers found that the effects of positive responses to sexual assault disclosure have

6
negligible effects on PTSD severity or recovery (Campbell et al., 2001), Ullman and Peter-

Hagene (2014) suggest that positive reactions to sexual assault disclosures were associated with

less PTSD symptoms, a greater sense of control in the recovery process, and a greater use of

adaptive coping, such as social coping (Ullman & Peter-Hagene, 2014). Positive responses from

informal support resources have also been shown to increase a survivor’s willingness to utilize

formal services; however, this association has only been shown to be true when survivor’s

informal support resources gave survivors control over reporting and disclosing the sexual

assault (e.g., letting them make decisions about making a police report and letting them decide

who is informed about the sexual assault) (Fehler-Cabral & Campbell, 2013).

In the extant literature, of the three examined informal support resources (friends, family,

and romantic partners), friends were shown to have more helpful reactions (e.g., provide

emotional support and tangible aid for survivors) and were the least likely to blame, control, or

have egocentric reactions to the assault (Ahrens et al., 2009). The inverse was true for romantic

partners (i.e., of the three groups, romantic partners were most likely to have hurtful reactions

and least likely to have helpful reactions). Family members scored in-between friends and

romantic partners on all variables (Ahrens et al., 2009).

Relyea and Ullman (2015) examined negative or hurtful reactions that survivors received

after disclosing a sexual assault and suggested that negative reactions can be divided into two

groupings, turning against, which consisted of consistently hurtful reactions such as blaming,

stigmatizing, controlling, or attacking the survivor, or unsupportive acknowledgment, which

consisted of distracting the survivor, or egocentric reactions (Relyea & Ullman, 2015). As has

been supported by previous research, survivors who received these negative reactions had

7
increased psychological symptoms (Ullman & Peter-Hagene, 2014; Relyea & Ullman, 2015; &

Campbell et al., 2001).

Previous literature has shown that a sexual assault can impact post-assault romantic

relationships in four ways; 1) previous sexual assault increases the risk of a subsequent sexual

assault, 2) sexual assault can increase or decrease a survivors frequency of sexual behavior, 3)

survivors may have PTSD after a sexual assault and PTSD symptoms can reduce relationship

satisfaction, and 4) when a survivor discloses a sexual assault to a romantic partner they may

receive hurtful reactions that can increase PTSD symptoms (DiMauro & Renshaw, 2019;

O’Callaghan et al., 2019; Walker et al., 2019; Relyea & Ullman, 2015; Messman-Moore et al.,

2013; Ullman & Peter-Hagene, 2014; Lambert et al., 2012; & Weaver, 2009). In my thesis

research I examine post-assault factors that impact a survivor’s romantic relationships.

The Research Project

The aim of my research was to expand previous research and examine post-assault

variables that impact dating relationships. I was particularly interested in sexual intimacy and

assault disclosure within relationships (O’Callaghan et al., 2019; Ahrens et al., 2009; &

Deliramich & Gray, 2008). Previous research has shown that sexual assault survivors may

increase or decrease their sexual activities, as compared to the frequency of their sexual activities

before the assault (O’Callaghan et al., 2019; & Deliramich & Gray, 2008). In this study, I

examined whether or not this change corresponded to survivor’s dating relationships post-sexual

assault (i.e., would survivors engage in risky dating or dating avoidance?). I was also interested

in what effect, if any, a sexual assault had on survivors who were in relationships. Post-

Traumatic Stress Disorder had been shown to increase relationship dissatisfaction (DiMauro &

8
Renshaw, 2019; & Metz & Epstein, 2002), but how PTSD relates to relationship satisfaction

after a college sexual assault is not well understood.

Additionally, other research has shown that survivors have negative and positive

experiences disclosing their sexual assaults to intimate partners (Ahrens et al., 2012); therefore, I

also examined survivors disclosing experiences. I specifically sought to examine the negative

reactions survivors received after disclosing their assault to a partner to better understand

survivors’ experiences in dating relationships.

In the methods section I describe the qualitative data I used to examine the relationship

between sexual assault and post-assault romantic relationships. My qualitative analysis generated

four themes, abusive and unhealthy relationships, dating apprehension, PTSD symptoms within a

dating relationship, and disclosing to a partner.

METHOD

The current study uses data collected by Potter and her colleagues (2018) during 30- to

60-minute phone interviews of 32 female participants who had been sexually assaulted while

completing a college degree. Interviews were transcribed for coding and stored in a locked

drawer. Participants were recruited after filing out a survey distributed over Amazon Mechanical

Turk (MTurk) or through an email sent to professionals in the violence prevention field. Potter

and her colleagues (2018) acknowledge that this selection process was not random and may have

biased the data. A full report of participant recruitment and interviewing methods can be found in

Potter et al. 2018.

Current Study Method:

I used Braun and Clarke’s (2012) six-phase approach to thematic analysis to create and

validate themes. This approach included gaining familiarity with the data, initial coding,

9
searching for potential themes, reviewing and validating potential themes, defining final themes,

and producing a report (Braun & Clarke, 2012). Some alterations were made to this approach as

a result of Covid-19 safety protocols which prohibited me from accessing the data from March

until late July.

The first step of data analysis was an initial read through of the interview transcriptions.

The read through familiarized me with the data and provided me with initial “building blocks” to

build themes (Braun & Clarke, 2012). At this stage, I looked for data relevant to intimacy,

relationships, and sexual assault disclosures but also looked for general patterns in the data (Lune

& Berg, 2018).

Originally, the themes “relationships,” and “intimacy” emerged from the data and I began

coding with these themes in mind (O’Callaghan et al., 2019; Hakimi et al., 2018; Turchik &

Hassija, 2014; Ahrens & Aldana, 2012; Ahrens et al., 2009; Weaver, 2009; Deliramich & Gray,

2008; & Ahrens et al., 2007). Although these two original themes addressed the research

questions (i.e., “do some survivors avoid romantic relationships and some engage in risky

dating?” and “what types of negative responses do survivors receive when they disclose a sexual

assault to a romantic partner?”), other themes emerged. In the first read through, the codes

“trust,” “coping,” “making meaning,” “substance use,” “vulnerability,” and “friends” were used

to help me keep track of and manage the data. Although I did not approach the data with these

codes in mind, they are consistent with previous research on sexual assault (Hannagan, 2017;

Ullman et al., 2013; & Ahrens et al., 2009).

These codes were recorded in my notes, which helped me to both think through and

reflect on the interview data and to consolidate the data into a more manageable quantity, as has

been recommended for qualitative analyses of over 30 participants (Deterding & Waters, 2018).

10
Given the unexpected COVID-19 restrictions, the notes also allowed me to access some data that

would otherwise not be available.

After the original reading and coding, I used the coded data to search for potential

themes. This was done by examining possible connections between codes and by grouping them

together (Braun & Clarke, 2012). The codes were collapsed into three main potential themes, (1)

“relationships,” which included the codes of challenges with intimacy, challenges opening up

about sexual assault, loss of friends, and challenges with trust and comfortability; (2) “making

meaning,” which included working in jobs that help sexual assault survivors or give back to the

community, and creating empathy; and (3) “continued vulnerability,” which consisted of not

feeling safe in specific groups or places, avoiding doctors, not trusting one’s self, and coping.

Braun and Clarke (2012) recommend reviewing potential themes by revisiting the

original data to test for quality. However, because of COVID-19 protocols that prohibited me

from accessing the data as mentioned above, this process was delayed and modified. Re-reading

my notes and gaining feedback from one of the original data collectors helped me define and

begin to validate the final themes. The potential theme “continued vulnerability” was subsumed

into the theme “relationships” because vulnerability often impacted, or was impacted by,

relationships. The theme “relationships” was then broken into four different themes that more

accurately depicted the data and addressed the research questions: forming relationships with

abusive partners, dating apprehension, challenges with intimacy and disclosing to a partner. The

theme of making meaning was excluded because many of the participants who joined the study

worked with survivors of sexual assault and this type of occupation may have biased the results

of this particular theme.

11
 When I reviewed the original transcripts to validate these themes, they were verified with

minor alterations. I re-read all transcriptions with the four themes in mind and found that the

themes that emerged from the notes were consistent over the entire dataset. With the entire

dataset in mind, themes were retitled to better represent the findings: abusive and unhealthy

relationships, dating apprehension, PTSD triggers within a dating relationship, and disclosing to

a partner.

RESULTS

Analysis of interview transcripts revealed that sexual assaults had long-term impacts on

intimate relationships. I examined changes in dating behavior that take place before a

relationship forms and during the span of a relationship. The analyzed data is presented here in

four major themes: abusive and unhealthy relationships, dating apprehension, PTSD triggers

within intimate relationships, and disclosing to a partner. As predicted, sexual assaults were

shown to effect survivors’ dating habits. Participants in this sample reported dating abusive

partners and entering unhealthy relationships. Participants also reported dating apprehension and

avoidance. Within dating relationships, survivors coped with experiencing triggers that caused

PTSD symptoms and distress within the relationship. Finally, participants reported that their

partners had negative reactions when they disclosed their sexual assault. These partners were

reported to either shame and belittle survivors or not know how to react to a sexual assault

disclosure.

Abusive and Unhealthy Relationships

More than one-third of the participants (n = 13) discussed being in an abusive or

unhealthy relationship at some point after the sexual assault. However, it is likely that other

participants did enter abusive or unhealthy relationships and did not report this to the researchers

12
in response to the question, “has the sexual assault impacted your romantic relationships?”

Current research has shown that about one-fourth of women and one-tenth of men report sexual

assault, physical assault, and/or stalking by an intimate partner (Smith, Zhang, Basile, Merrick,

wang, Kresnow, & Chen, 2018). For these participants, abusive behavior was somewhat

normalized and in some cases led to additional sexual assaults. In unhealthy relationships that

participants did not characterize as abusive, survivors were unable to connect emotionally with

their partners and engaged in risky sexual behavior.

When participants discussed being in an abusive relationship, they said that the behavior

was somewhat normalized as evidenced by one participant’s response.

I thought it [an abusive relationship] was normal… not necessarily normal but I

remember thinking there might have been some things wrong, but I just didn’t

really let myself think about it, just because I didn’t want… I don’t know if it was

fear or just not wanting to admit something was wrong or… but I do remember

thinking about it and just suppressing those feelings.

Another participant expressed that she became accustom to being a victim, and this

altered her perception of abuse and affection.

The first one [the first marriage], the assault played a huge part because I wasn’t

very affectionate at all. And that became an issue. But he was also abusive, which

I feel like maybe was because I had been a victim for so long. I wasn’t able to

differentiate between what it is to be a victim and what it is to actually be loved

by someone.

A pattern of abuse can also be perceived as normal or expected when it exists between

multiple partners. One participant who disclosed a history of abusive relationships reported that

13
she believes the sexual assault led her to attract abusive partners as suggested by her response,

“He [an intimate partner] was incredible creepy, and controlling, and invasive, and I think that

I’ve kind of tended to attract those kinds of men in my life since the incident.” This participant

was not the only one to draw a causal connection between the sexual assault and abusive

relationships. Another discussed that after the assault she was more accustomed to abusive

relationships and that healthy relationships were out of her comfort zone as evidenced by her

response, “It’s hard for me to be in a healthy relationship because I didn’t know what that was

before.”

Not only were participants likely to enter abusive relationships after a sexual assault, but

these relationships could lead to another sexual assault. In several cases, participants discussed

how dating abusive partners contributed to subsequent victimizations. One participant disclosed

her partner continued to assault her by stating, “I started drinking more. So, during the

relationship several of the assaults occurred while kind of just socially drinking with him and he

drugged my drinks and the drinking increased.”

Another participant described how her partner put her in situations where she would be

victimized.

I went to this party with my girlfriend and we wanted more drugs. I say “we”

because I wanted them as well, but we didn’t have enough money and there was a

guy there that had them. I felt like I was making her [the girlfriend] happy by

allowing him to do these [sexual things to me]… you have to couple it with the

fact that I was drinking, I was high, and that really took a long time to grasp the

concept that I should not have allowed her to put me into… that situation. [It]

meant that she didn’t care and the guy knew that he was taking advantage of me.

14
 Not all relationships that the participants entered into were abusive or led to more sexual

assaults; however, even relationships that were not labeled as abusive could have been

considered unhealthy. In these unhealthy relationships, the survivors reported that they were not

able to connect emotionally or continue the relationship for a long time. Although these

relationships were not necessarily abusive, they were unhealthy as they were characterized as

short, intense, lacking trust, and unsafe.

One participant suggested that the sexual assault led her to change her views on sexuality,

which, in turn, contributed to her to engagement of more promiscuous behavior.

I think the biggest way that it [the sexual assault] kind of changed was that the

concept of sex was pretty casual to me at that point, so I ended up cheating in a

number of relationships because it just kind of to me it wasn’t important, what’s

the big deal?

Another participant stated that she was not able to stay in a “monogamous relationship”

and attributed this to her inability to connect emotionally as well as her belief that sex “has to be

violent.”

As far as emotionally connecting with someone, that couldn’t happen… my

relationships were very, very intense or non-existent… even up until now. Five or

six months ago I was not capable of being in a monogamous relationship or any

steady relationship… My sexual behaviors were still very, very wild. A lot of

very unsafe sexual behavior still manifested in my behavior after all my therapy…

And the fact that I think sex has to be very violent, like you know, I don’t literally

think that but my body almost has to think that sex has to be violent or punishing

or cruel or, I don’t know. Something like that.

15
 Another participant attributed the sexual assault for behaviors that she otherwise would

not have engaged in, which she believed impacted her ability to emotionally connect.

My relationships and things were just kind of all over the place. I feel like [the

sexual assault] really did effect stuff, cause it was like, just doing things that I

probably would not have done… And [there] was never a relationship that I was

super close to… they were just… just not super… not on that level of being able to

connect with someone.

Although many participants sought short-term relationships after the sexual assault, this

was not always the case. One participant reported seeking a long-term relationship after the

assault. Like other participants, however, she regretted her relationship choice.

When I was raped, I decided I needed to find a long-term relationship, because I

had never been in one. So, as soon as I got home, I entered one, like the day I got

home… I realized that that probably wasn’t the best decision.

Dating Apprehension

An alternative response to entering an abusive relationship was avoiding relationships

altogether. Half of the participants (n = 16) described taking precautions when dating or

avoiding dating when they were asked how the sexual assault impacted their relationships.

Participants reported that they were apprehensive about dating because they lost trust in others,

increased their standards and sought better quality relationships, or because of PTSD symptoms.

Participants who were apprehensive about dating but dated anyways had short relationships and

ended relationships when the relationship triggered a PTSD symptom.

A common reason that participants were apprehensive about dating was because of their

loss of trust in others. One participant explained that she used to be trusting before the sexual

16
assault but now is less trusting. “I used to be more open right away with people. I don’t really do

that anymore. I definitely am less trusting of people coming into my life that I don’t really

know.”

One participant indicated that the loss of trust can be compounded when multiple assaults

occurred.

It made me pretty unwilling to date men for like a long time… I was really scared

to have sex again… and then it happened a second time. And I was really hesitant

about being sexual anymore. I was like, I’m never going to have sex again. I’m

never dating men again… I don’t really see any reason to just trust men… It

seems to me like time and time again they’re just gonna hurt me.

Another reason survivors were apprehensive of dating was because they increased their

standards for dating partners and were no longer willing to risk dating someone who would not

treat them how they wanted to be treated.

Now I kinda don’t have tolerance for any of kind of bullshit from men, so I’ve

just had… ever since [the sexual assault] I’ve just had really short relationships

where it’s like two or six months and I’m like, “Okay, you’re not good enough,”

and then move onto the next. So, I’m still single. I haven’t found my life

partner… Like if someone displays a lot of jealousy, or tries to control me, or

displays that they are kind of authoritarian and like they aren’t willing to like let

me be a part of decision-making around traditionally masculine things… if they

don’t see me as an equal in that stuff, then I’m quick to be like, “okay we’re not

doing this.”

17
 Another participant reiterated this same point in her response that, “I kind of am holding

out for Gandhi, but he’s dead already, so I’m probably not going to date much.”

Dating was also avoided because of PTSD symptoms. One participant disclosed that

PTSD kept her from dating when she stated that, “I had incredible PTSD and wasn’t able to go

out at night… I wasn’t able to form a relationship with people who reminded me of the sexual

assault… I kind of avoided all of the trigger areas.”

PTSD symptoms led some participants to lose interest in relationships as one participant

stated,

I think, in general, I have issues with freeze responses and disassociating, stuff

like that. So, I don’t feel particularly in control in situations like that and so I

generally kind of avoid them, with guys and things like that, and I also just don’t

get all that interested in them.

However, this was not always the case. Participants with PTSD may have wanted to form

intimate relationships, but were unable to because of their symptoms. One participant discussed

the tension of wanting a relationship but not being able to because of PTSD that resulted from

her assault.

My PTSD were very, very severe… I wasn’t able to be touched… [I was] dealing

with issues of intimacy because I wasn’t able to have any physical contact

whatsoever with men. I wanted to change – I was a hot-blooded young person and

I wanted that in my life but wasn’t able to.

Despite their apprehension, participants still tried dating. For some participants, dating

was a slow process with many setbacks, as one participant reported.

18
 I remember the first guy I probably dated. It was a number of dates before we

were ever very physically close. And I remember him kissing me and I broke it

off after that. And I never told him why or what happened, I just couldn’t handle

it.

In a similar experience, a different participant reported that she slowly began to date

again after the sexual assault and that she too ended relationships because of experiences that

triggered PTSD symptoms.

I didn’t date for – like at all – for a while, like a couple of years. And then I

slowly started dating again about I was guarded… I’d only see people a couple of

times and then I’d like, you know, done and then just avoid them… which in

retrospect, I’m sorry to all those people who have no idea like why I just

disappeared, but it was too much to try to let someone in… and then I met a

guy… that I had a relationship with for about four and a half years, and... I mean

the poor guy for the first probably like six months we were together there was a

lot of stuff that was really triggering.

PTSD Triggers within Dating Relationships

In the sample, approximately one-quarter of participants (n = 9) reported staying in a

relationship despite having PTSD symptoms while dating. All of these participants disclosed that

the PTSD triggers resulting from the sexual assault negatively affected the quality of the

relationship. The participants who stayed in relationships and disclosed having PTSD symptoms

that were activated at least partly because of the relationship revealed that PTSD symptoms

could occur after sexual contact, but also occurred as a result of any physical contact or even

without physical contact and impacted both the survivor and their partner.

19
 Although PTSD symptoms can be triggered by sexual behaviors, many participants

reported symptoms, such as anxiety, were triggered by unexpected non-sexual touching within

intimate relationships. One participant reported that, “I am very jumpy and any situation where I

am grabbed or touched, I mean, I’m just… I don’t know, it really gives me anxiety.”

Another participant also suggested that the sexual assault impacted her relationship because it

has led to “triggering” experiences.

I have huge trouble sleeping in beds with other people… I’ve been in a healthy

relationship for two years with my partner and even once and a while sleeping in

bed with him is tricky if he leans over me to grab something… It’s just a huge

trigger for me, sometimes it’s little things like that.

At other times triggers that lead to PTSD symptoms occurred without any physical

contact. Two participants discussed being triggered without being able to identify the triggering

event, as evidenced by one participant’s response.

But in more current relationship history I have had a tough time because there

have been times where I feel triggered and I don’t necessarily know why or like

something doesn’t feel right, or the tone of voice, you know, they’re just little

triggers where I have an emotional response and I have to back up and be like

what’s going on with me? Now, my partner isn’t doing anything to elicit that kind

of response and so its been tough with my current partner.

Further support for PTSD symptoms occurring without physical contact triggering the

symptom can be seen in another participant’s response.

As far as romantic relationships go it [the sexual assault] definitely is something

that is impactful. [In a relationship] it’s like you’re kinda always fighting this

20
 person of the past, so it’s like your relationship is only two people, but there’s a

third person that’s still kinda there.

Another outcome of PTSD symptoms was partner-distress. When survivors’ PTSD

symptoms were triggered, it negatively impacted their partners. One participant explains how her

PTSD led her partner to feel guilty.

The entire relationship has been impacted by that [the sexual assault]… there have

been a couple of times where while I’ve been intimate with my current partner,

I’ll have triggers. And it makes it kind of difficult and then he feels really bad

because he feels like it’s something he did and it’s not… It’s hard to make him

understand that it’s not his fault.

Disclosing to a Partner

A final theme that emerged was disclosing the sexual assault to a partner. Because

disclosing a sexual assault has been reported in the literature to impact the quality of

relationships (Campbell et al., 2001; & Ahrens et al., 2012), this research sought to better

understand what types of negative responses survivors received and what, if anything, predicted

those responses. Of the 32 participants, 15 discussed sharing the sexual assault with a partner.

Although some partners in the data were supportive during and after sexual assault disclosures,

10 had unhelpful or harmful responses. Of those 10, 4 partners blamed or belittled the survivor

for being sexually assaulted and 6 did not know how to react to the sexual assault.

According to the participants, several partners told the survivors that the assault was their

fault as described in one survivor’s response that, “In college [I] dated a person who I disclosed

the assault to and he was very abusive and he would throw it in my face and say, ‘well you

deserve to be raped.’”

21
 Other participants reported similar responses. One survivor shared that her partner, “was

pretty abusive and – more mental than physical – but he just always blamed me for it [being

sexually assaulted].”

Another survivor shared her experience.

I finally got the courage to tell the first person that I’ve been raped, and they gave

me herpes and that was a huge step for me. And his immediate reaction was,

“were you having a threesome when you were raped?”

Some participants described that their partners used the knowledge of the sexual assault

to belittle them. For some survivors, partners not only responded negatively and blamed them for

the assault, but continued to bring up the assault to shame and belittle them. One participant

stated, “and so, he got that information [about the rape] and used it to shame me… [The sexual

assault] interfered [with the relationship] because it was like giving him a can of gasoline and

matches, that information.”

Another participant shared a similar experience.

I got into an abusive situation for about 10 years, because it was kinda my sense

of normal. Unfortunately, he knew, in the beginning I told him about the assault

just because I was into disclosure and I thought he should know. But he ended up

using that sort of against me.

Other participants reported that their partners did not know how to respond to the sexual

assault and that this was also hurtful.

I had another one [partner] where like he really couldn’t understand what I’d be

going through and I’d try to talk to him about it and he wouldn’t really know what

to say or do and it was frustrating to me that he didn’t know how to help me…

22
 they tend to ignore it because they don’t know what to say or do and then I feel

very alone and neglected.

Occasionally, when partners did not know how to respond they would get upset or draw

attention to their own needs, as one participant stated.

When I talk about it or… he just gets very upset and angry because he feels like

he can’t do anything, he feels like at a loss and its causing a lot of stress… when

I’m going through things, he’ll complain of being sick a lot more or like having

physical problems and I think it’s related to what I’m going through.

Another survivor shared that her partner also did not know how to “handle” the assault

and ended the relationship because he did not want to “handle” it.

With any relationship that followed, I think it was a very heavy thing for them to

process. And, um… I remember someone I was casually dating, like I’d only gone

out maybe one or two dates. I had told [him] about [the sexual assault] and he was

like, “That’s too much for me. I can’t handle that, I’m sorry.”

DISCUSSION

I found that sexual assault impacts survivors’ long-term relationships in ways not

currently addressed in the extant literature. The findings provided insight into the research

questions regarding intimate relationships post-assault; dating post-sexual assault; and reactions

sexual assault survivors receive after disclosing the sexual assault to an intimate partner.

Analysis of transcripts revealed four themes that addressed these questions, abusive and

unhealthy relationships, dating apprehension, PTSD triggers within a dating relationship, and

disclosing to a partner. Here, I compare my findings to extant literature in the field.

Abusive and Unhealthy Relationships

23
 The results suggest that sexual assault survivors may seek risky dating partners or remain

in abusive and/or unhealthy relationships after the sexual assault. This is not surprising as

previous research has shown that survivors may engage in risky sexual behaviors, which mirror

behaviors in abusive and unhealthy relationships (O’Callaghan et al., 2019; Turchik & Hassija,

2014; Weaver, 2009; & Deliramich & Gray, 2008). In addition, survivors have been shown to

engage in sexual risk-taking behavior including having more sex, have more sexual partners,

have more sexual encounters while intoxicated, and selling sex (O’Callaghan et al., 2019;

Turchik & Hassija, 2014; & Deliramich & Gray, 2008). Consistent with past research, I found

that 13 of the participants entered into or remained in an abusive or unhealthy relationship after

the sexual assault. Analysis of these 13 participants’ interviews revealed that some of these

survivors held views that normalized abusive behavior, that some survivors who dated abusive

partners were re-victimized, that survivors who entered unhealthy relationships were unable to

emotionally connect with their partners, and that some survivors engaged in risky sexual

behaviors.

The finding that abusive behavior was normalized among some survivors mirrors other

research. Some participants were unsure if their abuse was wrong or were uncertain of the

differences between abusive and healthy relationships. Previous literature has shown that female

survivors who experience harassment and abuse may consider this normal sexual behavior (i.e.,

appraising the experience as nothing out of the ordinary), despite resisting it (i.e., fighting off an

attacker) (Halvaka, 2014). Normalization minimizes the behavior of the perpetrator and has also

been shown to be one of the reasons survivors do not report the assault (Holland & Cortina,

2017). Some researchers have suggested that sexually aggressive male behavior is an outcome of

adherence to a masculine gender role that teaches men to be dominant and aggressive and

24
teaches women to be inferior or even worthy of victimization (Muren et al., 2002). In the

interview transcripts, one survivor came to believe that she was worthy of victimization because

she had been a victim for so long, “I had been a victim for so long I wasn’t able to differentiate

between what it is to be a victim and what it is to actually be loved by someone.” These

narratives and beliefs may contribute to survivors’ appraisal of abusive partners as normal dating

relationships (Jackson & Cram, 2003).

Intimate partner violence (IPV), which includes sexual assault, is estimated to impact

approximately 30 percent of women (Smith et al., 2018; & Devies et al., 2013). In addition,

college students are at an extremely high risk of IPV, in that victimization rates are between 20

percent and 50 percent (Nabors, 2010). Therefore, the finding that some participants who dated

abusive partners were more likely to be sexually assaulted again is well supported by the

literature. Participants who discussed subsequent sexual assaults within dating relationships told

us that these assaults were at least partially related to drug or alcohol use. Other research has

shown a significant relationship between depressants, such as alcohol, and intimate partner

violence among college students (Nabors, 2010).

Finally, I found that some sexual assault survivors formed relationships that, although not

labeled as abusive, were unhealthy. Unhealthy relationships were characterized as short, intense,

lacking trust, and unsafe. Participants who entered unhealthy relationships were unable to

emotionally connect with their partners and engaged in sexual promiscuity. Many of these

findings are consistent with other literature, which found that sexual assault survivors engage in

unsafe and promiscuous sex (O’Callaghan et al., 2019; Turchik & Hassija, 2014; & Deliramich

& Gray, 2008). Therefore, the finding that these behaviors continued into dating relationships is

not surprising.

25
 This research expands on the previous research mentioned above and shows that sexual

assaults can contribute to survivors’ dating abusive partners and forming unhealthy relationships.

Specifically, I found that sexual assaults were, in some cases, tied to the normalization of abusive

behavior. I also found that dating (not just having sex after a sexual assault) can lead to more

sexual assaults. Finally, I found that when survivors were in unhealthy relationships, they tended

to engage in promiscuous sex and cheating, shifted their perceptions of sex to a more casual and

less significant activity, or were unable to emotionally connect with their partners.

Dating Apprehension

The findings indicate that some sexual assault survivors may be apprehensive about

dating or avoid dating following a sexual assault. This finding was expected as previous research

has shown that sexual assault survivors are likely to avoid intimacy or have fewer sexual

interactions (O’Callaghan et al., 2019; Turchik & Hassija, 2014; Weaver, 2009). Post-sexual

assault sex-avoidant behavior has been attributed to mental health outcomes associated with

those sexual assaults (e.g., anxiety, PTSD) and physical outcomes associated with those sexual

assaults (e.g., genital injury, pain, STIs) (Turchik & Hassija, 2014; Weaver, 2009; Amar &

Gennaro, 2005; Sadler et al., 2000; & Van Berlo & Ensink, 2000). Extending past research, I

found that some survivors were apprehensive and avoided dating after a sexual assault for three

main perceived reasons, including not trusting potential partners, increasing dating standards for

better quality relationships, or avoiding situations that could trigger PTSD symptoms.

Many of the participants who were apprehensive towards dating revealed that they were

not trusting of other people, especially dating partners. Although previous research has shown

that survivors are less trusting of others and of sexual partners (O’Callaghan et al., 2019; Holland

et al., 2016; Shakespear-Finch et al., 2010 & Dunmore et al., 1999), these results indicate that the

26
of loss of trust in others following a sexual assault also may be a reason for dating avoidance or

apprehension.

Similar to O’Callaghan and her colleagues (2019), who conducted a qualitative study on

survivors and sexuality after an assault, I found that some survivors lost interest in having sex

after the sexual assault. However, I also found that some survivors who were apprehensive about

dating did want to date and engage intimately with partners, but were unable to do so for other

reasons, such as PTSD symptoms. These finding indicate that it is possible that PTSD affects

survivors’ relationships in two ways: (1) it lowers relationship quality because of symptoms that

emerge in the relationship (Doray et al., 2013) and (2) it keeps survivors out of relationships

because they do not want to experience symptoms. In other words, survivors are affected by

PTSD symptoms and the fear of having PTSD symptoms. The fear of PTSD symptoms is what

appears to affect survivors’ dating apprehension and avoidance.

PTSD Triggers within a Dating Relationship

There are a variety of responses survivors have to sexual assaults; although some avoid

dating, others continue to have dating relationships (O’Callaghan et al., 2019). Because sexual

assault has been strongly associated with PTSD, it is not surprising that PTSD symptoms emerge

in these relationships (DeCou et al., 2019; Dworkin et al., 2017; & Dworkin et al., 2016).

Approximately one-third of the participants in this study maintained a relationship with a

romantic partner despite having PTSD symptoms within the relationship. Participants who

discussed that their relationship contributed to them having a PTSD trigger shared that triggering

experiences could be sexual, but could also be non-sexual physical contact or no contact at all.

Further, when a survivor was triggered in a relationship, it impacted the quality of the

relationship for both the survivor and the partner.

27
 Previous research has indicated that trauma negatively affects the quality of relationships.

Disassociation, PTSD symptom severity, decreased communication, decreased connection, and

sexual intimacy problems have all been associated with poorer relationship satisfaction

(DiMauro & Renshaw, 2019; Doray et al, 2013; & Nelson Goff et al., 2006). Previous research

has shown that survivors may not want to have sex because it may trigger anxiety or a PTSD

flashback, regardless of whether they are related to intimacy or not and that this may lead to

increase relationship distress (Nelson Goff et al, 2006). However, other research has indicated

that neither the role of mental health symptoms (e.g., anxiety, depression) nor the role of sexual

intimacy served an intermediate role between sexual assault and relationship satisfaction

(Georgia et al, 2018). Georgia and her colleagues (2018) suggest that other factors, such as poor

communication, intimate partner violence, and emotional intimacy mediate the relationship

between sexual assault and relationship satisfaction.

Disclosing to a Partner

The final theme in this analysis, disclosing the sexual assault to a partner, includes the

analysis of negative responses participants received when they disclosed the sexual assault to

someone they were dating. Previous literature has shown that reactions to disclosures can be

either helpful of hurtful to the survivor and that intimate partners are more likely to have hurtful

responses than other informal social groups (Ahrens et al., 2012; & Campbell et al., 2001).

Although participants in this study were not directly asked about disclosure, 15 discussed talking

to a partner about the sexual assault. Of the 15, 10 received negative reactions, 4 partners

intentionally blamed the survivor for the sexual assault or tried to use the assault to belittle them

and 6 partners had harmful responses because they did not know how to react.

28
 Negative reactions to sexual assault disclosures (e.g., treating the survivor differently,

taking control of the situation, blaming the survivor, egocentric reactions) are harmful to the

survivor and are associated with maladaptive coping, including being less likely to use support

services and to disclose again, and being more likely self-blame, have PTSD symptoms, and

have depression (Orchowski & Gidycz, 2015; Littleton, 2010; & Ahrens, 2006). Disclosures

about sexual assault are far more likely to occur with informal support providers (e.g., friends,

family, romantic partners) than formal support providers (police agencies, campus authorities,

counseling services, or other authority figures) and, therefore, informal support providers have

the greatest opportunity to react in a way that is helpful or harmful to survivors (Fisher et al.,

2003). Of the informal support survivors, romantic partners are the most likely to have hurtful

responses to a sexual assault disclosure (e.g., lowest amount of tangible aid, highest amount of

blame, control, and egocentric behaviors) (Ahrens et al., 2009). The finding that two thirds of

participants who disclosed a sexual assault to a romantic partner received a hurtful response is,

therefore, consistent with the extant research on this issue.

I found that negative reactions to sexual assault disclosure fit two categories, blaming the

survivor for the assault and not knowing how to react to the assault. These two categories are

similar to findings by other researchers. Relyea and Ullman (2015) also grouped negative

reactions to sexual assault disclosure into two categories, turning against (which consisted of

consistently hurtful reactions such as blaming, stigmatizing, or attacking the survivor) and

unsupportive acknowledgement (which consisted of distracting the survivor, or egocentric

reactions). They found that survivors who were “turned against” had greater social withdrawal,

increased self-blame, and decreased sexual assertiveness, while those who received

29
“unsupportive acknowledgement” developed both adaptive and non-adaptive coping strategies

(Relyea & Ullman, 2015).

Other Findings

In this qualitative study, there were some participants who did not neatly fit into any

theme, that is to say, some participants successfully formed healthy relationships with romantic

partners. Although our interview question, “did the sexual assault impact your romantic

relationships?” did not invoke much discussion on positive dating experiences, some participants

mentioned that they participated in healthy romantic relationships. There is little research on

what factors aid survivors in developing healthy romantic relationships after a sexual assault;

however, some studies have shown that making meaning of the sexual trauma, participating in

advocacy movements such as the #MeToo movement, and using mental health services, such as

therapy, can help survivors positively cope with the crime that has been committed against them

(Swanson & Szymanski, 2020; Belleville et al., 2018; & Vilenica et al., 2013). Positive coping

could reduce the barriers to healthy relationships that result from PTSD symptoms such as

increased risky sexual behavior and fear that dating will lead to triggering a PTSD symptom.

Research also indicates that social support, such as positive responses to a sexual assault

disclosure can help survivors positively cope with the sexual assault (Orchowski & Gidycz,

2015; Littleton, 2010; & Ahrens, 2006). From these findings, it may be the case that there are

two main factors that contribute to a survivor’s successfulness in forming a healthy relationship,

their personal ability to positively cope with the sexual assault and their support systems’, which

may include a romantic partner’s, ability to positively respond to and support the survivor.

Participants in this study who had relationships that they held in positive regard indicated that

their partners were supportive of them and helpful in their recovery.

30
Preliminary Analysis of the Relationship of Post-Sexual Assault Variables

In my thesis research I examined how sexual assault may impact post-assault

relationships. The post-assault variables detailed in the thesis may predict outcomes in dating

relationships following a sexual assault. In particular, I found that there are three main dating

possibilities for survivors of sexual assault. Survivors may avoid dating altogether, be

apprehensive about dating, or engage in risky dating behavior. I have developed a figure, Figure

1., to show illustrated possible relationship outcomes sexual assault survivors may face (see

Figure 1. Preliminary Analysis of the Relationship of Post-Sexual Assault Variables).

Figure 1. Preliminary Analysis of the Relationship of Post-Sexual Assault Variables

As shown in Figure 1., sexual assault can lead to loss of trust, coping skills, and PTSD

symptoms. The data in the thesis research suggests that the impact of sexual assault (loss of trust,

coping, and/or PTSD symptoms) may result in survivors avoiding dating, being apprehensive

about dating, and engaging in risky dating behaviors.

Of these three possibilities, survivors who avoid dating and survivors who engage in

risky dating have fewer positive relationship outcomes compared to survivors who are

31
apprehensive about dating. Survivors who avoid dating altogether do not experience any other

symptoms of the sexual assault within a dating relationship; however, because not dating is a

form of avoidant coping, it is likely that these survivors still experience the physical and mental

harm inflicted on them. Avoidant coping, or a behavior that manages stress by avoiding a

stressor, can increase PTSD severity and length of recovery (Pineles et al., 2011). Therefore, it is

likely that those who did not experience relationship distress because they avoided relationships

altogether, still experienced PTSD symptoms (Ullman et al., 2007).

Survivors who engage in risky dating behaviors may have adverse outcomes. They may

be at a higher risk for sexual assaults, more likely to enter into unhealthy or abusive

relationships, or date romantic partners that have hurtful reactions to their sexual assault

disclosures (see Figure 1). The post-assault variables that were associated with risky dating

behaviors were similar to finding in the literature indicating risky sexual behavior can lead to

adverse outcomes, such as subsequent sexual assaults (Messman-Moore et al., 2010). Some of

the women in the study disclosed that abusive partners had negative reactions to their sexual

assault disclosures. The relationship between negative reactions to a sexual assault disclosure

and abusive partners is supported by previous literature that has shown that some romantic

partners may have hurtful reactions and even attack survivors who choose to disclose (Relyea &

Ullman, 2015). Because revictimization seems to be more likely in risky dating and

revictimization increased PTSD symptoms (Messman-Moore et al., 2010), it is likely that risky

dating is associated with greater PTSD symptoms and less trust in others (O’Callaghan et al.,

2019; & Turchik & Hassija, 2014).

In Figure 1, I show that participants who were apprehensive about dating set healthy

boundaries and dated at their own pace, but still reported PTSD symptoms within their dating

32
relationships and received a mix of positive and negative reactions from dating partners when

they disclosed a previous sexual assault. A mix of positive and negative responses to sexual

assault disclosure and stress within survivors’ dating lives is consistent with other research on

survivors and their relationships (DiMauro & Renshaw, 2019; Lambert et al., 2012; & Ahrens et

al., 2009). However, this preliminary research suggests that survivors who were apprehensive

about dating were less likely to experience further victimizations and had greater social support

then those who engaged in risky dating behavior. Although my thesis focused on more negative

aspects of dating after a sexual assault, other research has shown that partners may be supportive

of survivors and want to help them in their recovery (O’Callaghan et al., 2019). Those

participants who reported they were apprehensive about dating also provided themselves the

opportunity to work through their fear of dating and their PTSD symptoms at their own pace by

leaving relationships when their PTSD symptoms occurred. Entering into a relationship and then

exiting it when PTSD symptoms emerged is a similar behavior that clients practice in exposure

therapies, in which trauma survivors are exposed to trauma memories and reminders in treatment

as a way to reduce PTSD symptoms (Foa et al., 2018). Furthermore, the reduced risk of

revictimization for survivors who are apprehensive about dating could partly be explained by the

finding that those who were apprehensive about dating tended to set higher standards for

potential dating partners. By refusing to date potential partners who would not respect the

survivor or by ending relationships that had unhealthy characteristics, the survivors in this study

who were apprehensive about dating set healthy boundaries that decreased their perceived risk of

further victimization and could increase their likelihood of dating supportive partners (Byers et

al., 2016).

33
 Although these three categories can be somewhat predictive of the relationships survivors

have after a sexual assault, it is also possible that some survivors do not stay in one category. In

this sample, some participants moved through these different categories either by engaging in

risky dating behavior directly after the assault and then becoming apprehensive about dating, by

avoiding dating all together and then dating selectively, or by being apprehensive about dating

and then engaging in risky dating.

LIMITATIONS

This study has several limitations. Most notably, I was unable to review the transcripts

throughout most of the coding process. Policy resulting from COVID-19 prohibited me from

looking at any transcript data from March 2020 to the end of July 2020, at which point I had

access to the transcripts for no more than 8 hours. As a result, I relied on notes about the

transcripts to develop themes, that may have been created with greater accuracy if I had greater

access to the transcripts.

The recruitment of participants is another limitation in this study. Participant collection

occurred either through responses to a posting on the Amazon Mechanical Turk crowdsourcing

website or through a Listserv for professionals in the field for sexual violence prevention and

response. Those who responded through the Amazon Mechanical Turk crowdsourcing website

were more representative of the overall sexual assault survivor population as this survey was

available to any Amazon Mechanical Turk user. However, those who responded through the

Listserv were exclusively professionals in the field. Although it is unknown if working in the

field would affect one’s healing journey or understanding of their sexual assault, it is conceivable

that participants who work in the field would be more aware of how their sexual assault has

34
impacted them and have greater knowledge of sexual assaults then the general population.

Therefore, the generalizability of these findings is limited.

Another limitation in this study is the potential unequal opportunity for participants to

discuss how their sexual assault impacted their relationships. Because interviewers were not only

interested in how sexual assaults affect relationships, it is possible that participants were

prompted to discuss the impact sexual assault had on their relationship at various degrees. An

interview designed to capture information directly about the impact sexual assault had on

relationships would have provided a more complete scope of this issue.

Finally, the effect demographic variables (e.g., race, ethnicity, sexuality) have on the

relationship between sexual assault and relationships were not examined in this study. Only

participants who identified as female partook in this study; therefore, the findings are not

generalizable to other gender identities. Further research is needed to understand the effects of

sexual assaults on other gender identities as well as the variance of these effects across other

demographic variables.

CONCLUSIONS AND FUTURE DIRECTIONS

It is clear that survivors’ intimate relationships are impacted after a sexual assault. As

predicted, survivors’ dating behaviors varied. Some survivors were apprehensive about dating or

avoided dating all together. These participants were not trusting of potential partners, had high

standards for dating, or avoided dating because of PTSD symptoms. Other survivors dated but

ended up in abusive or unhealthy relationships. Survivors in abusive relationships viewed

abusive behavior as somewhat normal, and, in some cases, were re-victimized in their

relationship. Of the survivors that formed unhealthy relationships, some reported that they were

unable to emotionally connect with their partner, viewed sex as something insignificant or

35
something that should be dangerous, or engaged in promiscuous sexual behavior. Of the

participants who did enter more supportive relationships, PTSD symptoms seemed to impact the

quality of their relationships. Survivors reported that their PTSD was triggered during intimacy,

physical contact, and at other times when no contact was made. Some survivors also reported

that their partners had a hard time understanding them when they had PTSD triggers and didn’t

know how to react. This research also analyzed the impact disclosing a sexual assault has on

relationships and found that, for some survivors, disclosing a sexual assault was met with hurtful

responses, such as partners blaming the survivor for the sexual assault or using the sexual assault

to belittle them. Some partners did not know how to react to the disclosure of a sexual assault,

which survivors also found to be hurtful. Finally, I identified three responses to sexual assaults

that may predict other post-assault variables relating to romantic relationships: dating avoidance,

dating apprehension, and risky dating.

Further research should continue to examine variables that predict post-assault outcomes

on romantic relationships. Although I suggest that dating apprehension is a protective variable

that increases survivor’s likelihood of forming healthy relationships and minimizes the risk of

abusive and unhealthy relationships, further research should evaluate this proposal. A better

understanding of the ways survivors approach dating relationships and how these approaches

increase or decrease their risk of post-assault variables could help clinicians guide survivors in

making healthy relationship choices and help researchers better understand these mediators of

post-assault variables.

Although this research explores several ways sexual assault hinders healthy post-assault

romantic relationships and leads to unhealthy relationship dynamics, it does not address

predictors that contribute to the initial sexual assault. One predictor of sexual assault is adverse

36
childhood experiences (ACEs) (Ports et al., 2016). A single ACE has been shown to multiply the

risk of adult sexual assault by 1.77 and childhood sexual assault (CSA), a type of ACE, has been

shown to increase the risk of adult sexual assault by 3 times (Ports et al., 2016). Previous

research has also indicated that ACE is positively associated with increased risky behavior, risky

sexual behavior, IPV as an adult, PTSD, and chronic avoidance (i.e., an unwillingness to remain

in contact with unpleasant private experiences such as emotions, thoughts, sensations, or

memories) (Campbell et al., 2016; Schalinski et al., 2016; Mair et al., 2012; Rosenthal et al.,

2005; & Whitfield et al., 2003). However, research has not yet examined the degree to which

sexual assault is not only predicted by ACE, but also mediates the relationship between ACE and

post-ACE outcomes or, how ACE mediates the relationship between sexual assault and post-

assault variables. Research that examines this relationship would contribute to our understanding

of these populations and better address the needs of survivors.

This research signals the need for a better understanding of the impacts sexual assaults

have on dating relationships. Many participants avoided dating or ended up in abusive or

unhealthy relationships. To better support survivors, researchers and practitioners need to know

what barriers survivors have to healthy relationship satisfaction and how those barriers can be

overcome. These results show that some barriers to healthy relationships include dating

apprehension, fear of experiencing PTSD symptoms, being triggered and having PTSD

symptoms, the inability to emotionally connect, promiscuous sexuality, and dating abusive

partners. Clinicians can target these barriers in therapeutic interventions so survivors will be

better prepared to enter healthy relationships. Because existing research has labeled emotional

intimacy as perhaps the most important variable in determining relationship satisfaction post-

37
assault, clinicians may want to teach this skill to survivors who are interested in dating

relationships (Georgia et al, 2018).

Furthermore, the findings signal the need for intervention programs, such as bystander

education programs that teach all members of a social ecology how to prevent sexual assaults

and how to support survivors. Previous research has indicated that survivors predominantly

disclose to informal resources (Ahrens et al., 2009; Ahrens et al., 2007; & Fisher et al., 2003);

however, these resources may not be trained to appropriately respond to a sexual assault, which

can result in further harm to the survivor (Relyea & Ullman, 2015; & Ahrens & Aldana, 2012).

In this study, 6 survivors received harmful responses from dating partners after disclosing a

sexual assault because these partners did not know how to properly respond to a sexual assault.

Knowledge of this gap provides an opportunity for skill training that would help partners support

survivors.

Current results from a qualitative study indicate that survivors suggest that those to whom

they disclose their sexual assault be supportive listeners without showing pity or trying to rescue

the survivor (Kirkner et al., 2017). They also suggest they use anti-blaming messages, such as

assuring survivors that the assault was not their fault (Kirkner et al., 2017). Teaching these

communication skills would provide survivors with better support; however, more research

should be done to determine how bystanders can best prevent sexual assault and support

survivors.

There is also a need to support survivors who are in abusive relationships. The results

from this study and others indicate that sexual assault survivors may feel like they deserve to be

in unhealthy relationships or that abusive behavior is normal (Muren et al., 2002). To support

these survivors, prevention programs should deconstruct myths that justify or normalize abusive

38
relationships and should teach bystanders how to support survivors who are in abusive

relationships.

Despite the limitations outlined above, this study contributes to the scientific

understanding of sexual assault survivors. Specifically, the contributions of this research advance

knowledge on the post-assault variables that impact romantic relationships. This paper not only

validated previous findings on post-assault impacts on sexuality and post-assault victimization,

but also provided evidence that adverse sexual behaviors such as risky dating and risky

promiscuity impact survivors and their dating partners. This research also add to the literature by

providing evidence that PTSD symptoms, and the fear of PTSD symptoms, contribute to

survivors’ dating apprehension and impact survivors and their partners while in a dating

relationship and flagged the importance of bystander training programs that can teach potential

partners how to respond to a sexual assault disclosure.

39
 LIST OF REFERENCES

Aaron, M. (2012). The pathways of problematic sexual behavior: A literature review of factors
affecting adult sexual behavior in survivors of childhood sexual abuse. Sexual Addiction
& Compulsivity, 19(3), 199-218.

Abbey, A., Zawacki, T., Buck, P. O., Clinton, A. M., & McAuslan, P. (2004). Sexual assault and
alcohol consumption: What do we know about their relationship and what types of
research are still needed? Aggression and violent behavior, 9(3), 271-303.

Ahrens, C. E., & Aldana, E. (2012). The ties that bind: Understanding the impact of sexual
assault disclosure on survivors' relationships with friends, family, and partners. Journal
of Trauma & Dissociation, 13(2), 226-
243. https://doi.org/10.1080/15299732.2012.642738

Ahrens, C. E., Cabral, G., & Abeling, S. (2009). Healing or hurtful: Sexual assault survivors'
interpretations of social reactions from support providers. Psychology of Women
Quarterly, 33(1), 81-94.

Ahrens, C. E., Campbell, R., Ternier-Thames, N. K., Wasco, S. M., & Sefl, T. (2007). Deciding
whom to tell: Expectations and outcomes of rape survivors' first disclosures. Psychology
of Women Quarterly, 31(1), 38-49.

Ahrens, C. E. (2006). Being silenced: The impact of negative social reactions on the disclosure
of rape. American journal of community psychology, 38(3-4), 263-274.

Ahrens, C. E., PhD & Aldana, E. (2012) The Ties That Bind: Understanding the Impact of
Sexual Assault Disclosure on Survivors' Relationships with Friends, Family, and
Partners, Journal of Trauma & Dissociation, 13:2, 226-
243. https://doi.org/10.1080/15299732.2012.642738

Al-Turkait, F. A., & Ohaeri, J. U. (2008). Prevalence and correlates of posttraumatic stress
disorder among Kuwaiti military men according to level of involvement in the first Golf
War. Depression & Anxiety (1091-4269), 25(11), 932-941.

Amar, A; F., & Gennaro, S. (2005). Dating violence in college women: Associated physical
injury, healthcare usage, and mental health symptoms. Nursing Research, 54(4), 235-242.

Baker, M. R., Frazier, P. A., Greer, C., Paulsen, J. A., Howard, K., Meredith, L. N., Anders, S.
L., & Shallcross, S. L. (2016). Sexual victimization history predicts academic
performance in college women. Journal of Counseling Psychology, 63(6), 685.

Braun, V., & Clarke, V. (2012). Thematic analysis. In H. E. Cooper, P. M. Camic, D. L. Long,
A, T. Panter, D. E. Rindskopf, & K. J. Sher, APA handbook of research methods in

40
 psychology: Research designs: Quantitative, qualitative, neuropsychological, and
biological. (Vol. 2). (pp. 57 – 71). The American Psychological Association.

Byers, E. S. (2002). Evidence for the importance of relationship satisfaction for women's sexual
functioning. Women & Therapy, 24(1-2), 23-26.

Byers, E. S., O’Sullivan, L. F., & Brotto, L. A. (2016). Time out from sex or romance: Sexually
experienced adolescents’ decisions to purposefully avoid sexual activity or romantic
relationships. Journal of youth and adolescence, 45(5), 831-845.

Campbell, J. A., Walker, R. J., & Egede, L. E. (2016). Associations between adverse childhood
experiences, high-risk behaviors, and morbidity in adulthood. American journal of
preventive medicine, 50(3), 344-352.

Campbell, R., Ahrens, C. E., Sefl, T., Wasco, S. M., & Barnes, H. E. (2001). Social reactions to
rape victims: Healing and hurtful effects on psychological and physical health
outcomes. Violence and victims, 16(3), 287-302.

Cantor, D., Fisher, B., Chibnall, S., Bruce, C., Townsend, R., Thomas, G., & Lee, H. (2015).
Report on the AAU campus climate survey on sexual assault and sexual misconduct.
Westat.

Carey, K. B., Norris, A. L., Durney, S. E., Shepardson, R. L., & Carey, M. P .(2018). Mental
health consequences of sexual assault among first-year college women. Journal of
American College Health, 66(6), 480-486. http://doi-
org.unh.idm.oclc.org/10.1080/074481.2018.1431915

Chang, E. C., Schaffer, M. R., Novak, C. J., Ablow, D. B., Gregory, A. E., Chang, Olivia D.,
Lucas, A. G., & Hirsch, J. K. (2019). Sexual assault history and self-
destructive behaviors in women college students: Testing the perniciousness of
perfectionism in predicting non-suicidal self-injury and suicidal behaviors. Personality
and Individual Differences, 149, 186-191.

Cortina, L. M., Swan, S., Fitzgerald, L. F., & Waldo, C. (1998). Sexual harassment and assault:
Chilling the climate for women in academia. Psychology of Women Quarterly, 22(3),
419-441.

Coulter, R. W., Mair, C., Miller, E., Blosnich, J. R., Matthews, D. D., & McCauley, H. L.
(2017). Prevalence of past-year sexual assault victimization among undergraduate
students: Exploring differences by and intersections of gender identity, sexual identity,
and race/ethnicity. Prevention Science, 18(6), 726-736.

DeCou, C. R., Mahoney, C. T., Kaplan, S. P., & Lynch, S. M. (2019). Coping self-efficacy and
trauma-related shame mediated the association between negative social reactions to
sexual assault and PTSD symptoms. Psychological Trauma: Theory, Research, Practice,

41
 and Policy, 11(1), 51-54. http://doi.org.unh.idm.oclc.org/10.1037/trapppp379.supp
(Supplemental).

Deliramich, A. N., & Gray, M. J. (2008). Changes in women's sexual behavior following sexual
assault. Behavior Modification, 32(5), 611-621.

Deterding, N. M., & Waters, M. C. (2018). Flexible coding of in-depth interviews: A twenty-
first-century approach. Sociological methods & research, 1-32. doi: 0049124118799377.

DiMauro, J., & Renshaw, K. D. (2019). PTSD and relationship satisfaction in female survivors
of sexual assault. Psychological trauma: theory, research, practice, and policy, 11(5),
534-541. https://doi.org/10.1037/tra0000391

Dworkin, E. R., Menon, S. V., Bystrynski, J., & Allen, N. E. (2017). Sexual assault victimization
and psychopathology: A review and meta-analysis. Clinical psychology review, 56, 65-
81.

Dworkin, E. R., Mota, N. P., Schemacher, J. A., Vinci, C., & Coffey, S. F., (2017). The unique
associatins of sexual assault and intimate partner violence with PTSD symptom clusters
in a traumatized substance-abuse sample. Psychological Trauma: Theory, Research,
Practice, and Policy, 9(4), 500-508. http://doi.org.unh.idm.oclc.org/10.1037/tra0000212

Fehler-Cabral, G., & Campbell, R. (2013). Adolescent sexual assault disclosure: The impact of
peers, families, and schools. American Journal of Community Psychology, 52(1-2), 73-
83. doi: 10.1007/s10464-013-9577-3

Foa, E. B., McLean, C. P., Zang, Y., Rosenfield, D., Yadin, E., Yarvis, J. S., Mints, J., Young-
McCaughan, S., Borah, E. V., Dondanville, K. A., Fina, B. A., Hall-Clark, B. N.,
Lichner, T., Litz, T. B., Roache, J., Wright, E. C., & Peterson, A. L. (2018). Effect of
prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs present-centered
therapy on PTSD symptom severity in military personnel: A randomized clinical
trial. Jama, 319(4), 354-364.

Fisher, B. S., Daigle, L. E., Cullen, F. T., & Turner, M. G. (2003). Reporting sexual
victimization to the police and others: Results from national-level study of college
women. Criminal Justice and Behavior, 30(1), 6-38.

Georgia, E. J., Roddy, M. K., & Doss, B. D. (2018). Sexual assault and dyadic relationship
satisfaction: Indirect associations through intimacy and mental health. Violence against
women, 24(8), 936-951.

Gilmore, A., K. & Flanagan, J., C. (2020). Acute mental health symptoms among individuals
receiving a sexual assault medical forensic exam: The role of previous intimate partner
violence victimization. Archives of Women's Mental Health, 23, 81–89.

42
Hakimi, D., Bryant-Davis, T., Usman, S. E., & Gobin, R. L. (2018). Relationship between
negative social reactions to sexual assault disclosure and mental health outcomes of black
and white female survivors. Psychological Trauma: Theory, Research, Practice, and
Policy. 10(3), 270-275. doi: 10.1037/tra0000245

Hannagan, R. J. (2017). “I believe we are the fewer, the prouder”: Women’s agency in meaning-
making after military sexual assault. Journal of Contemporary Ethnography, 46(5), 624-
644.

Holland, K. J., & Cortina, L. M. (2017). “It happens to girls all the time”: Examining sexual
assault survivors’ reasons for not using campus supports. American journal of community
psychology, 59(1-2), 50-64.

Holland, K. J., Rabelo, V. C., & Cortina, L. (2016). See something, do something: Predicting
sexual assault bystander intentions in the US military. American journal of community
psychology, 58(1-2), 3-15.

Jackson, S. M., & Cram, F. (2003). Disrupting the sexual double standard: Young women's talk
about heterosexuality. British journal of social psychology, 42(1), 113-127.

Johnson, L. M., Matthews, T. L., & Napper, S. L. (2016). Sexual orientation and sexual assault
victimization among US college students. The Social Science Journal, 53(2), 174-183.

Jordan, C. E., Combs, J. L., & Smith, G. T. (2014). An exploration of sexual victimization and
academic performance among college women. Trauma, Violence, & Abuse, 15(3), 191-
200.

Kirkner, A., Lorenz, K., & Ullman, S. E. (2017). Recommendations for responding to survivors
of sexual assault: A qualitative study of survivors and support providers. Journal of
interpersonal violence, 1, 1-24. doi: 0886260517739285.

Kilpatrick, D. G., Resnick, H. S., Ruggiero, K. J., Conoscenti, L. M., & McCauley, J.
(2007). Drug-facilitated, incapacitated, and forcible rape: A national study. Charleston,
SC: National Criminal Justice Reference Service.

Kohn, M., Flood, H., Chase, J., McMahon, P. M., & Centers for Disease Control and Prevention
(CDC) (2000). Prevalence and health consequences of stalking--Louisiana, 1998-
1999. MMWR. Morbidity and mortality weekly report, 49(29), 653–655.

Lambert, J. E., Engh, R., Hasbun, A., & Holzer, J. (2012). Impact of posttraumatic stress
disorder on the relationship quality and psychological distress of intimate partners: A
meta-analytic review. Journal of Family Psychology, 26(5), 729.

Letica-Crepulja, M., Stevanović, A., Protuder, M., Popović, B., Salopek-Žiha, D., & Vondraček,
S. (2019). Predictors of sexual dysfunction in veterans with post-traumatic stress
disorder. Journal of Clinical Medicine, 8(4), 432. doi:10.3390/jcm8040432

43
Littleton, H. L. (2010). The impact of social support and negative disclosure reactions on sexual
assault victims: A cross-sectional and longitudinal investigation. Journal of Trauma &
Dissociation, 11(2), 210-227.

Lune, H., & Berg, B. L. (2018). Qualitative research methods for the social sciences (9th
edition). Pearson.

Mair, C., Cunradi, C. B., & Todd, M. (2012). Adverse childhood experiences and intimate
partner violence: Testing psychosocial mediational pathways among couples. Annals of
epidemiology, 22(12), 832-839.

Mengo, C., & Black, B. M. (2016). Violence victimization on a college campus: Impact on GPA
and school dropout. Journal of College Student Retention: Research, Theory &
Practice, 18(2), 234-248.

Metz, M. E., & Epsten, N. (2002). Assessing the role of relationship conflict in sexual
dysfunction. Journal of Sex and Marital Therapy, 28, 139-164.

Messman-Moore, T. L., Walsh, K. L., & DiLillo, D. (2010). Emotion dysregulation and risky
sexual behavior in revictimization. Child abuse & neglect, 34(12), 967-976.

Mohler-Kuo, M., Dowdall, G. W., Koss, M. P., & Wechsler, H. (2004). Correlates of rape while
intoxicated in a national sample of college women. Journal of studies on alcohol, 65(1),
37-45.

Murnen, S. K., Wright, C., & Kaluzny, G. (2002). If “boys will be boys,” then girls will be
victims? A meta-analytic review of the research that relates masculine ideology to sexual
aggression. Sex roles, 46(11-12), 359-375.

O’Callaghan, E., Shepp, V., Ullman, S. E., & Kirkner, A. (2019) Navigating sex and sexuality
after sexual assault: A qualitative study of survivors and informal support providers. The
Journal of Sex Research, 56(8),1045-1057. doi: 10.1080/00224499.2018.1506731

Office of Civil Rights (2015, April, 21). Addressing sexual assault as a community. The Official
Blog of the U.S. Department of Education. https://blog.ed.gov/2015/04/addressing-
sexual-assault-as-a-community/

Orchowski, L. M., & Gidycz, C. A. (2015). Psychological consequences associated with positive
and negative responses to disclosure of sexual assault among college women: A
prospective study. Violence Against Women, 21(7), 803-823.

Perilloux, C., Duntley, J. D., & Buss, D. M. (2011). Susceptibility to sexual victimization and
women’s mating strategies. Personality and Individual Differences, 51(6), 783-786.

44
Pineles, S. L., Mostoufi, S. M., Ready, C. B., Street, A. E., Griffin, M. G., & Resick, P. A.
(2011). Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating
relationship?. Journal of abnormal psychology, 120(1), 240.

Potter, S. J., Howard, R., Murphy, S., Moynihan, M. M. (2018). Long-term impacts of college
sexual assault on women survivors’ educational career attainments. Journal of American
College Health. 66(6), 496-507.

Ports, K. A., Ford, D. C., & Merrick, M. T. (2016). Adverse childhood experiences and sexual
victimization in adulthood. Child abuse & neglect, 51, 313-322.

RAINN (2020). Sexual Assault. https://www.rainn.org/articles/sexual-assault

Relyea, M., & Ullman, S. E. (2015). Unsupported or turned against: Understanding how two
types of negative social reactions to sexual assault relate to postassault
outcomes. Psychology of women quarterly, 39(1), 37-52.

Rosenberg, M., Townes, A., Taylor, S., Luetke, M., & Herbenick, D. (2018). Quantifying the
magnitude and potential influence of missing data in campus sexual assault surveys: A
systematic review of surveys, 2010–2016, Journal of American College Health, doi:
10.1080/07448481.2018.1462817

Rosenthal, M. Z., Hall, M. L. R., Palm, K. M., Batten, S. V., & Follette, V. M. (2005). Chronic
avoidance helps explain the relationship between severity of childhood sexual abuse and
psychological distress in adulthood. Journal of Child Sexual Abuse, 14(4), 25-41.

Rosellini, A. J., Street, A. E., Ursano, R. J., Wai Tat Chiu, Heeringa, S. G., Monahan, J., Naifeh,
J. A., Petukhova, M. V., Reis, B. Y., Sampson, N. A., Bliese, P. D., Stein, M. B.,
Zaslavsky, A. M., & Kessler, R. C. (2017). Sexual assault victimization and mental
health treatment, suicide attempts, and career outcomes among women in the US army.
American Jurnal of Public Health, 107(5), 732-739. https://doi-
org.unh.idm.oclc.org/10.2105/AJPH.2017.303693

Sadler, A. G., Booth, B. M., Nielson, D., & Doebbeling, B. N. (2000). Health-related
consequences of physical and sexual violence: Women in the military. Obstetrics &
Gynecology, 96(3), 473-480.

Schalinski, I., Teicher, M. H., Nischk, D., Hinderer, E., Müller, O., & Rockstroh, B. (2016).
Type and timing of adverse childhood experiences differentially affect severity of PTSD,
dissociative and depressive symptoms in adult inpatients. BMC psychiatry, 16(1), 295.

Schou-Bredal, I., Bonsaksen, T., Ekeberg, Ø., Skogstad, L., Grimholt, T. K., Lerdal, A., & Heir,
T. (2020). Sexual Assault and the Association With Health, Quality of Life, and Self-
Efficacy in the General Norwegian Population. Journal of Interpersonal Violence, 1-24.
doi: 0886260520926307

45
Sugar, N. F., Fine, D. N., & Eckert, L. O. (2004). Physical injury after sexual assault: Findings of
a large case series. American Journal of Obstetrics and Gynecology, 190(1), 71-76.

Smith, S. G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M. J., & Chen, J.
(2018). The national intimate partner and sexual violence survey (NISVS): 2015 data
brief–updated release. Atlanta, GA: National Center for Injury Prevention and Control,
Centers for Disease Control and Prevention.

Swanson, S. C., & Szymanski, D. M. (2020). From pain to power: An exploration of activism,
the #MeToo movement, and healing from sexual assault arauma. Journal of Counseling
Psychology. http://dx.doi.org/10.1037/cou0000429

Taft, C. T., Watkins, L. E., Stafford, J., Street, A. E., & Monson, C. M. (2011). Posttraumatic
stress disorder and intimate relationship problems: a meta-analysis. Journal of consulting
and clinical psychology, 79(1), 22.

Turchik, J. A., & Hassija, C. M. (2014). Female sexual victimization among college students:
Assault severity, health risk behaviors, and sexual functioning. Journal of Interpersonal
Violence, 29(13), 2439-2457.

Ullman, Sarah E., and Leanne R. B. (2002). Sexual assault history and suicidal behavior in a
national sample of women. Suicide and Life-Threatening Behavior, 32(2), 117-130.

Ullman, S. E., & Peter‐Hagene, L. (2014). Social reactions to sexual assault disclosure, coping,
perceived control, and PTSD symptoms in sexual assault victims. Journal of community
psychology, 42(4), 495-508.

Ullman, S. E., Relyea, M., Peter-Hagene, L., & Vasquez, A. L. (2013). Trauma histories,
substance use coping, PTSD, and problem substance use among sexual assault
victims. Addictive behaviors, 38(6), 2219-2223.

Ullman, S. E., Townsend, S. M., Filipas, H. H., & Starzynski, L. L. (2007). Structural models of
the relations of assault severity, social support, avoidance coping, self-blame, and PTSD
among sexual assault survivors. Psychology of Women Quarterly, 31(1), 23-37.

Vaillancourt-Morel, M. P., Dugal, C., Stewart, R. P., Godbout, N., Sabourin, S., Lussier, Y., &
Briere, J. (2016). Extradyadic sexual involvement and sexual compulsivity in male and
female sexual abuse survivors. Journal of Sex Research, 53 (4-5), 614-625.

Van Berlo, W., & Ensink, B. (2000). Problems with sexuality after sexual assault. Annual review
of sex research, 11(1), 235-257.

Vilenica, S., Shakespeare-Finch, J., & Obst, P. (2013). Exploring the process of meaning making
in healing and growth after childhood sexual assault: A case study approach. Counseling
Psychology Quarterly, 26(1), 39-54. http://doi-
org.unh.idm.oclc.org/10.1080/09515070.2012.728074

46
Walker, H. E., Freud, J. S., Ellis, R. A., Fraine, S. M., & Wilson, L. C. (2019). The prevalence of
sexual revictimization: A meta-analytic review. Trauma, Violence, & Abuse, 20(1), 67-
80.

Weaver, T. L. (2009). Impact of rape on female sexuality: Review of selected literature. Clinical
Obstetrics and Gynecology, 52, 702–711. doi:10.1097/GRF.0b013e3181bf4bfb

Whitfield, C. L., Anda, R. F., Dube, S. R., & Felitti, V. J. (2003). Violent childhood experiences
and the risk of intimate partner violence in adults: Assessment in a large health
maintenance organization. Journal of interpersonal violence, 18(2), 166-185.

Wu, P., Bird, H. R., Liu, X., Duarte, C. S., Fuller, C., Fan, B., Shen, S., Canino, G. J. (2010).
Trauma, posttraumatic stress symptoms, and alcohol-use initiaition in children. Jurnal of
Studies on Alcohol and Drugs. 71(3), 326-334. doi: 10.15288/jsad.2010.71.326

47