Assessment of psychological distress and disability after sexual assault in adults

Sexual assault involves any attempted or completed sexual act, ranging from intentional sexual contact against a victims will or without a victims consent to forcible sexual intercourse. Bureau of Justice statistics estimated about 250,000 sexual assaults occurred in 2002 alone (US Department of Justice, 2003). Although sexual violence affects both sexes, women are clearly more likely than men to be victims and men perpetrate the majority of sexual violence (DeLahunta and Baram, 1997). According to the National Violence Against Women Survey, 1 in 6 women and 1 in 33 men have experienced attempted or completed sexual assault (Tjaden and Thoennes, 2000). Rates of sexual assault are even higher among some populations, such as women seeking mental health treatment (Goodman et al., 2001) and women serving in the military. For example, nearly a quarter of female veterans report having experienced sexual assault during their military service (Hankin et al., 1999). The Department of Veterans Affairs (VA) is currently the largest provider of treatment for Posttraumatic Stress Disorder (PTSD) in the United States. PTSD is a chronic disabling condition caused by witnessing or experiencing a life-threatening and horrifying, traumatic event and is the most common psychiatric condition for which veterans seek VA disability benefits (Frueh et al., 2000; Statistics, 1995). As the occurrence of sexual assault while serving in the military has gained recognition, the rate of claims for disability secondary to sexual assault has increased (Murdoch et al., 2003). Thus, a significant number of female veterans apply for and receive benefits or compensation related to sexual assault that occurred while serving in the military. Moreover, claims for federal disability through the Social Security System have also increased steadily in recent years, with mental stresses as one of the most frequently cited reasons for disability claims (Arbisi, 2005). Given the high rates of sexual violence among clients presenting for mental health treatment and increasing rates of disability claims, there is a strong likelihood that psychologists will see patients who present with problems that may serve as the basis for a claim of disability or compensation. Practicing psychologists must be aware of sexual trauma issues and regularly screen for these events in their patients histories. Although psychologists providing treatment to sexual assault victims should not serve in the dual roles of treating professional and forensic expert, the treating professional must be familiar with disability issues and be aware that his or her assessment conducted in a treatment setting could later become evidence for a subsequent disability claim in a litigation context. Given this, any assessment of a sexual assault victim presenting for treatment should carefully address issues of causality, impairment, and subsequent disability with the view that whatever conclusion is reached may be challenged, and objective evidence is required in support of such conclusions. As we will discuss in this chapter, a multimethod assessment strategy, including the use of structured and semistructured interviews, objective psychological testing, and focused self-report questionnaires, can greatly assist the psychologist in making judgments regarding the validity of a claim of disability and support an opinion regarding the level of distress that may lead to compromised adaptive functioning and serve as a cause of damage.