Secondary Victims of Rape

Abstract

Rape is often a very traumatic experience, which affects not only the primary victim (PV) but also his/her significant others. Studies on secondary victims of rape are few and have almost exclusively studied male partners of female rape victims. This study examined the impact of rape on 107 secondary victims, including family members, partners, and friends of male and female rape victims. We found that many respondents found it difficult to support the PV and that their relationship with the PV was often affected by the assault. Furthermore, the sample showed significant levels of traumatization, and it was estimated that approximately one quarter of the respondents suffered from posttraumatic stress syndrome (PTSD). Degree of traumatization was associated with a more recent assault, higher efforts to support the PV, recurrent thoughts about having been able to prevent the assault, a lack of social support for the respondent, and feeling let down by others. The respondents were generally interested in friend-, family-, and partner-focused interventions, particularly in receiving education about how best to support a rape victim. [PUBLICATION ABSTRACT]

Headnote

Rape is often a very traumatic experience, which affects not only the primary victim (PV) but also his/her significant others. Studies on secondary victims of rape are few and have almost exclusively studied male partners of female rape victims. This study examined the impact of rape on 107 secondary victims, including family members, partners, and friends of male and female rape victims. We found that many respondents found it difficult to support the PV and that their relationship with the PV was often affected by the assault. Furthermore, the sample showed significant levels of traumatization, and it was estimated that approximately one quarter of the respondents suffered from posttraumatic stress syndrome (PTSD). Degree of traumatization was associated with a more recent assault, higher efforts to support the PV, recurrent thoughts about having been able to prevent the assault, a lack of social support for the respondent, and feeling let down by others. The respondents were generally interested in friend-, family-, and partner-focused interventions, particularly in receiving education about how best to support a rape victim.

Keywords: rape; secondary victims; posttraumatic stress disorder; social support; blame; intervention

It is widely acknowledged that rape is highly stressful for the victim and that the negative consequences may be long lasting. However, less attention has been paid on how rape affects the significant others of the primary victim (PV). Studies on significant others of rape victims have confirmed the view that rape is a shared crisis that affects both the PV and the people who care about him/her, as it produces abrupt changes in the balance of interpersonal relations and family systems (Banyard, Moynihan, Walsh, Cohn, & Ward, 2010; Emm & McKenry, 1988; Feinauer & Hippolite, 1987). Ahrens and Campbell (2000) used victimization perspective theory to explain how friends trying to help a rape victim are affected. According to this theory, friends believe they should help the PV cope with the rape but when their efforts prove ineffective, they feel helpless and frustrated, which puts further strain on them and on their relationship with the PV.

In accordance with Ahrens and Campbell's theory, significant others often find it difficult to know how best to help and support rape victims (Ahrens & Campbell, 2000; Brookings, McEvoy, & Reed, 1994; Remer & Elliott, 1995). Men may be more likely, than women, to feel that their help is ineffective and to be confused about how best to help (Ahrens & Campbell, 2000; Banyard et al., 2010). Such insecurities can result in the secondary victim withdrawing from the PV. Even so, in a study of college students, nearly two thirds of the sample felt that they had provided good support for their sexually assaulted friends (Banyard et al., 2010).

Problems related to communication are often reported as a consequence of rape (Emm & McKenry, 1988; Riggs & Kilpatrick, 1990). For example, both primary and secondary victims may be afraid to say something wrong, they may wish to avoid reminding the other part of the assault, or they may not want to burden the other part with feelings and thoughts related to the rape. Furthermore, following the rape, many secondary victims- particularly males-become extremely protective toward the PV (Brookings et al., 1994; Emm & McKenry, 1988; Gilbert,1998). Although this does not necessarily constitute a problem, overprotective behavior may be experienced as a restraint by the PV and may as a result cause tension in the relationship.

A rape may be especially straining on romantic relationships because many rape victims experience sexual problems as a direct consequence of the rape (Haansbæ k, 2005). The fact that a rape can severely damage romantic relationships is made evident by the fact that 50%-80% of female rape victims lose their boyfriends or husbands in the aftermath of the assault (Orzek, 1983). However, despite the high number of negative consequences that a rape can have on relationships, some friends and partners actually report that their relationship with the PV has become closer and more intimate after the assault (Ahrens & Campbell, 2000; Haansbæ k, 2005).

The attribution of guilt and blame is often important to the significant others of rape victims. Most secondary victims primarily blame the attacker for the assault and anger as well as wanting revenge are frequently reported-particularly by male significant others (e.g., Ahrens & Campbell, 2000; Haansbæ k, 2005; Smith, 2005). However, some secondary victims feel that the PV is at least partly to blame for the assault (e.g., Haansbæ k, 2005; Smith, 2005). Male college students have been reported to place more blame on the PV than female college students (Ahrens & Campbell, 2000), suggesting that sex differences may exist in the distribution of blame following sexual assault. Family members, friends, and partners may have conflicted feelings toward the PV as they may be affected by prejudice and myths concerning rape and it may be painful for them to be confronted with the suffering of the PV (Feinauer & Hippolite, 1987). Finally, significant others of rape victims-particularly fathers and husbands/boyfriends-often report feelings of guilt related to not having been able to prevent the assault (e.g., Haansbæ k, 2005; Smith, 2005).

The newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 2000) states that a situation in which a person is confronted with an event involving a threat to the physical integrity of others, such as a sexual assault, can result in posttraumatic stress disorder (PTSD). Consistent with the A2 criterion of the PTSD diagnosis, both shock (Banyard et al., 2010; Haansbæ k, 2005) and feelings of helplessness and powerlessness (Emm & McKenry, 1988; Haansbæ k, 2005; Rodkin, Hunt, & Cowan, 1982; Smith, 2005) are frequently reported as initial reactions to learning about the rape of someone close. This opens up for the possibility that a rape may not only cause PTSD in the PV but also in his/her significant others. In the aftermath of rape, secondary victims have been found to display some of the same symptoms that are found in PVs, including fearfulness, rage, and depression (Emm & McKenry, 1988). Recurrent thoughts about what could have been done to prevent the rape, a reluctance to talk about the rape with the PV or others, and constant fear for the safety of one self or the PV are common symptoms in secondary victims of rape and may represent re-experiencing, avoidance, and arousal symptoms of the PTSD diagnosis.

However, despite the fact that the family, friends, and partners of rape victims are often very affected by the assault, only little research has been carried out that focuses on these secondary victims of rape and research in recent years is almost completely absent. What little research has been conducted has almost exclusively studied the male partner of female rape victims and focuses more on the ability of the partner to help and support the PV than on the traumatic impact on the partner. Two more recent studies (Ahrens & Campbell, 2000; Banyard et al., 2010) have studied college students who had learned about the sexual assault of a friend. Ahrens and Campbell (2000) found that unlike what has been reported in the literature on family and partners, friends were generally not distressed but still reported feelings of anger and revenge. Banyard et al. (2010) reported that women experienced greater emotional distress than men in response to the disclosure of a sexual assault suffered by a friend. Although these two more recent studies contribute greatly to our knowledge of friends of PVs, they are limited by their sole focus on college students and do not assess the traumatic impact of disclosure on participants. We know of no studies that have examined the prevalence of PTSD in secondary victims of rape. This study adds to the existing body of research by examining how the assault affects the friends, family, and partners of both male and female treatment-seeking rape victims. Although the primary focus of this study is on individual reactions, particularly PTSD, we will also examine how the secondary victims experience the support they provide for the PV, as well as how the relationship with the PV is affected by the rape. The study is mostly explorative; but based on what little research has been carried out and on findings from other studies of secondary traumatization, we aimed to test the following hypotheses:

1. Partners of rape victims will experience more problems in their relationship with the PV than will friends and family.

2. Compared to females, male significant others will find it more difficult to help the PV, feel that their efforts to help are less effective, report more overprotective behavior, and be more likely to blame both themselves and the PV for the rape.

3. A substantial proportion of secondary victims of rape will report clinically significant levels of PTSD.

4. In accordance with the findings by Ahrens and Campbell (2000), we expect to find that friends report lower levels of PTSD than family and partners of rape victims.

5. Consistent with findings across studies of PTSD (Christiansen & Elklit, 2008; Olff, Langeland, Draijer, & Gersons, 2007) and in accordance with the results of Banyard et al. (2010), we expect that women will report more PTSD symptomatology than men.

METHOD

Procedure

Data gathering took place from March 2006 to August 2008 at the Centre for Rape Victims (CRVs) at the University Hospital of Aarhus, Denmark. The primary aim of the CRV is to assist victims of sexual assault by offering medical, legal, and psychological assistance in the aftermath of rape. A secondary goal is to conduct research into the aftermath of rape and to educate the population and relevant professional groups on important subjects, such as rape prevention and dealing with victims of sexual assault (for more information, see Bramsen, Elklit, & Nielsen, 2009; Elklit & Christiansen, in press). Rape victims who came into contact with the CRV during this period were introduced to the study by letter and asked to nominate friends, family members, and/or romantic partners who knew of the rape for participation in the study. In some cases, it was estimated by the psychologists at the CRV that inquiring about the study would increase stress levels in the PV and consequently, these were not asked to nominate significant others for participation in the study. The remaining PVs could chose not to nominate anybody or to nominate as many persons for the study as they chose. Participants were not given any information on the PV and the responses of participants could not be traced back to the PVs who had nominated them for participation in the study, thus securing confidentiality for both PVs and participants.

Participants were contacted relatively soon after the assault (M 5 4.3 months, SD 5 7.1) with 33.7% being contacted within the first month. Questionnaires and a prepaid return envelope was sent to the friends, family, and partners of the PVs along with a letter describing the purpose of the study and ensuring the participants that their responses were voluntary and confidential. Two to four weeks after the questionnaires were sent out, participants received a phone call that served both as a reminder to participants who had forgotten to fill-out the questionnaire and as an opportunity to ask questions about the purpose of the study or specific questions in the questionnaire. Finally, it provided the CRV with an opportunity to gather information on how participants had experienced filling out the questionnaire if they had already done so.

Sample

There were 197 questionnaires sent out, of which 107 were returned, giving a 54% response rate. Most (92%) of the PVs were female and ages ranged from 12 to 70 years with a mean age of 21 years and a median age of 19 (SD 5 8.9). All male PVs were aged between 14 and 22 years. As was the case with the PVs, most (79%) of the participants were women. Ages ranged between 16 and 85 years with a mean age of 39 years and a median age of 43 years (SD 5 14.6). The largest group of participants (66%) were family members of PVs (43% mothers, 11% fathers, 10% sisters), 21% were friends of PVs, and only 7% were married to or dating a PV. The remaining 6% had other relationships with the PV such as colleagues. Whereas some participants learned about the rape at the day of the assault, others were not told until up to 5 months after. In average, respondents learned about the assault 5 days after it had occurred (M 5 5.0, SD 5 17.8).

Measures

A questionnaire package designed for this study included several open-ended questions including the participants' relationship with the PV and their initial reactions to learning about the rape. Furthermore, several scales assessing changes and problems in the relationship with the PV were designed for the study. Problems in the relationship with the PV were assessed by a dichotomous yes/no measure and participants who answered yes to having had problems in their relationship were asked to describe them. Furthermore, participants were asked to indicate on a categorical measure whether the rape had affected their relationship with the PV (no, better, worse for a while, still worse). Overprotective behavior, support efforts, support difficulties, and satisfaction with the support given were all assessed by 4-point Likert scale ranging from 1 (no) to 4 (very much). Recurrent thoughts about having been able to prevent the assault were assessed by a 5-point Likert scale ranging from 1 (never) to 5 (all the time). Blame attributed to the self and the perpetrator were both assessed by a 5-point Likert scale ranging from 1 (not at all) to 5 (a lot), whereas blame attributed to the victim was assessed by a 4-point Likert scale ranging from 1 (not at all) to 4 (a lot). Participants were asked to indicate on a dichotomous measure whether they had been seeing a therapist in relation to dealing with the assault. Perceived need for help as well as interest in (further) sessions with a psychologist, education about how best to help and support a PV, and meeting other secondary rape victims were all assessed on a 4-point Likert scale ranging from 1 (no) to 4 (very much). Finally, the questionnaire included some standardized questionnaires.

Traumatization

The Harvard Trauma Questionnaire (HTQ part IV; Mollica et al., 1992) consists of 31 items, 16 of which are used to calculate a total score indicating PTSD severity, as well as three subscale scores corresponding to the three core criteria of the DSM-IV diagnosis (American Psychiatric Association, 2000). The answers are scored on a 4-point Likert scale ranging from 1 (not at all) to 4 (all the time). The total score ranges from 16 to 64, and the possible score range on the three subscales is 4-16 (re- experiencing, four items), 7-28 (avoidance, seven items), and 5-20 (arousal, five items). Item scores higher than 3 indicate symptom presence. An estimated PTSD diagnosis requires the presence of at least one re-experiencing symptom, three avoidance symptoms, and two arousal symptoms. The HTQ does not assess the A2 criterion of the DSM-IV PTSD diagnosis. However, participants were asked to describe their reactions to first learning about the event, which may give some overall idea of the initial experience of fear, horror, and helplessness in the sample. Participants were instructed to fill out the questionnaire in relation to symptoms that were experienced within the past month and that were related to the assault. The HTQ has good internal consistency, test-retest reliability, and concurrent validity (Mollica et al., 1992) and the Danish version of the scale has been well validated (Bach, 2003). Alpha values in this study were .86 for the HTQ total score and .76, .71, and .78 for the re-experiencing, avoidance, and arousal subscales, respectively.

Social Support

Social support given to the participant by others at the time when they first learned about the rape and at the time of the study was assessed using the Crisis Support Scale (CSS; Joseph, Andrews, Williams, & Yule, 1992). The CSS is a 7-item scale assessing perceived social support from others after a traumatic event. The items include perceived availability of others, emotional support, practical support, contact with people in a similar situation, ability to express oneself, experience of being let down, and overall satisfaction with received social support. Items are rated on a 7-point Likert scale ranging from 1 (never) to 7 (always). Thus, positive social support has a possible score range from 6 to 42 and feeling let down is scored from 1 to 7. The CSS has been shown to have good reliability and validity (Elklit, Pedersen, & Jind, 2001). The alpha value for the scale in this study was .74 at the time of disclosure and .73 at the time of the study.

Statistics

Gender differences in the sample were examined by x2 test for independence (using Yates Continuity Correction) in the case of categorical variables and by t test analyses in the case of continuous variables. Participants were divided into four groups based on their relationship with the PV, friends, family, partner, or other. Only the three first groups were included in analyses examining differences across groups because the "other" group was considered too heterogeneous to provide any meaningful results in such analyses. Group differences in the sample (comparing family, friends, and partners) were examined using x2 tests for independence in the case of categorical variables, whereas group differences in mean scores on continuous variables were examined using ANOVA tests with post-hoc comparisons using the Tukey HSD test. Finally, a hierarchical linear regression analysis was conducted in order to examine the combined effects of several variables on HTQ total score in the sample. A significance level of 95% was used in all statistical analyses.

RESULTS

Many of the participants acknowledged the importance of the study either during the phone call or in the questionnaire. Several participants noted that they found themselves in a situation where help was needed but none was offered. They therefore hoped that by participating in this study, they could help document a need for help in secondary victims of rape. Furthermore, several participants found this possibility to focus on how the rape had affected them very helpful because the main focus in the aftermath of the rape had been on the reactions and needs of the PV.

Attribution of Guilt

An important topic for primary as well as secondary rape victims is the attribution of blame and responsibility in relation to the assault. Blame was mostly attributed to the rapist, but as can be seen in Table 1, some responsibility could also be attributed to the PV or to the secondary victim who was unable to protect the PV and to prevent the assault from happening. An ANOVA analysis revealed that friends blamed the PV significantly more for the assault than did family members (M 5 1.64, SD 5 .95 vs. M 5 1.21, SD 5 .48; p # .05). Romantic partners did not differ significantly from either of the two groups, and there were no other group or gender differences.

Even though most of the respondents did not feel responsible for the rape, more than half (66%) had thoughts about having been able to prevent the assault. Whereas 17% reported having these thoughts rarely, 21% had them sometimes, 20% had them on a regular basis, and 8% reported that such thoughts were constantly present. There were no gender or group differences in the reported experience of such thoughts.

Supporting the Primary Victim

Despite the fact that not all respondents believed that the PV was entirely without fault in the rape, all respondents answered that they had tried to support the PV (see the first column of Table 2). However, most respondents (77%) found this support difficult (see the second column of Table 2). Difficulties in relation to helping the PV varied across the sample but could generally be divided into four main categories:

1. Own feelings (not wanting to think/know about the rape, being distressed, not wanting to burden the victim).

2. Insecurities about how to help (not knowing when it is okay to ask about the rape and the emotional state of the PV, not knowing what the PV wants,, not knowing-and perhaps having doubts about-what happened).

3. The reactions of the PV (PV experiencing unstable moods, suicide thoughts, self-blame, the respondent finding it difficult to understand the reactions of the PV, PV not wanting physical contact).

4. PV refusing help (PV not wanting to talk, not wanting help, exclusively using other sources of support).

Difficulties relating to the secondary victims own feelings and the reactions of the PV were only reported by a minority of those respondents who found it hard to support the PV (12% and 15%, respectively). In contrast, 27% experienced that the PV refused the help offered and finally, 41% experienced insecurities about how best to help. Despite these problems related to supporting the PV, the respondents were generally satisfied with the support they had offered the PV (see the third column of Table 2). There were no gender or group differences in either support efforts, support difficulties, or support satisfaction.

Consequences for the Relationship With the Primary Victim

When asked about how the rape had affected their relationship with the PV, half the participants (49%) stated that they had experienced no change. Of the remaining half, most of them (29%) stated that they felt closer to the victim than they did before the assault, 19% reported that the relationship had gotten worse for a while but was now back on track, and finally, 2% reported that the relationship had gotten worse and still suffered as a result of the rape. As can be seen in Table 3, more than half the partners in the study (57%) reported that their relationship to the PV had gotten worse as a result of the rape. In comparison, 22% of family members and only 14% of the friends reported a similar change for the worse. However, x2 analyses revealed that these differences were not significant. There was no difference in several males and females who reported that their relationship with the PV had gotten worse as a result of the rape.

Despite the fact that most respondents did not report that their relationship with the PV had gotten worse, about half (56%) reported that they had experienced some problems in their relationship as a result of the rape. Problems in the relationship with the PV were reported by 44% of family members, 36% of friends, and as much as 71% of partners in the study. However, these group differences did not reach significance. Males and females did not differ in their reporting of problems in their relationship with the PV. The problems reported by these participants could generally be divided into four categories:

1. Communication problems (the participant found it difficult to talk about the rape, the PV didn't want to talk about it)

2. Insecurity (not knowing how to deal with the situation, holding back in relation to the PV, not knowing whether it was okay to ask about the assault, not knowing how to act in front of the victim)

3. Not approving of how the PV dealt/deals with the assault (discrepancies in the reactions of the PV and the participant)

4. Increased concern for the PV (overprotective behavior, fear for another assault, concern regarding the welfare of the PV)

Of those who reported problems in their relationship, 32% experienced communication problems, 13% reported insecurity, 22% stated that they had a problem with how the PV dealt/deals with the assault, and finally, 10% reported excessive worrying about the PV. None of the partners disclosed sexual problems in the relationship. When asked specifically about overprotective behavior toward the PV, 88% of the respondents reported that they had been at least a little overprotective (33% a little, 35% somewhat, 20% very overprotective). An ANOVA test revealed that partners were significantly more overprotective than friends (M 5 3.29, SD 5 .49 vs. M 5 2.32, SD 5 .99; p # .05). Family did not differ significantly from either of the two groups, and there was no gender difference.

Traumatization

Participants were asked about their immediate reactions to being told about the assault. Responses could be divided into four categories:

1. Emotional reactions (sadness, fear/anxiety, anger, wanting to take revenge)

2. Cognitive reactions (guilt, feeling powerless, worrying about the victim, considering reporting the assault to the police)

3. Physical reactions (somatic symptoms, shock)

4. Active reactions (contacting relevant organizations [e.g., police, CRV]; protective behavior toward the victim)

The most commonly reported responses were sadness, anger, and shock (40%-52%) followed by worrying about the victim, feeling powerless, and contacting relevant organizations (10%-21%). The mean score on the HTQ was 31.3 (SD 5 8.6). The three core criteria for a PTSD diagnosis were met by 24% of the participants and an additional 36% suffered from subclinical PTSD, falling just one avoidance or arousal symptom short of a full diagnosis. Most participants fulfilled the re-experiencing and arousal criteria (79% and 64%, respectively). In contrast, only 28% reported a minimum of three avoidance symptoms. Neither gender nor relationship with the PV was significantly associated with the HTQ total score or PTSD status.

Relationship Between the HTQ Score and the Other Variables

To examine the relationship between degree of traumatization measured by the HTQ total score and the other variables, we conducted several correlation analyses (Table 4). Overprotective behavior, increased support efforts, thoughts about having been able to prevent the rape, and feeling let down, both at the time of disclosure and at the time of the study, were all significantly and positively correlated with the HTQ total score. Positive supports at the time of disclosure and at the time of the study were both significantly and negatively correlated with the HTQ total score. Neither relationship problems, support difficulties, support satisfaction, or blaming oneself for the assault were significantly related to the HTQ total score.

All the variables that correlated significantly with the HTQ total score were entered into a hierarchical linear regression analysis. First, to enter the model was time since the assault, which was used as a control variable. At the second step, overprotective behavior and support efforts were entered as variables concerning the relationship between the respondent and the PV. At the third step, thoughts about having been able to prevent the assault was entered, as this variable is related to how the participant relates to his or her own role in relation to the assault. Finally, measures of positive support and feeling let down by others both at the time of disclosure and at the time of the study were entered as variables that may have an impact on how respondents cope with the rape and its aftermath.

Only overprotective behavior was not significantly associated with the HTQ total score after the other variables were controlled for in the final step. Instead, the amount of time that had passed since the assault, support efforts, thoughts about having been able to prevent the assault, positive support at the time of the study, and feeling let down at the time of the study were all significant at the final level of analysis, and together these five variables accounted for 43% of the HTQ total score variance (see Table 5).

Help Needs for the Secondary Victims

Because the main focus of this study was on how the friends, family, and partners of rape victims respond to the rape of a loved one, we asked participants about their own need for help following the assault. One third of the sample (33%) reported that they had not felt any need for help in the time between the assault and the assessment. Another third (31%) reported that they had needed a little help to cope with the assault, and finally the last third of the respondents were equally divided into two groups reporting that they had felt somewhat or very much in need of help. In accordance with these figures, only one third of the sample (30%) reported having seen a psychologist or another type of therapist in relation to the assault. There were no gender differences in reported need for help or in relation to having seen a therapist. In contrast, an ANOVA analysis revealed that family reported a significantly higher need for help than friends (M 5 2.41, SD 5 1.08 vs. M 5 1.67, SD 5 .86; p # .05), and a x2 test for independence (using Yates Continuity Correction) revealed that friends were significantly less likely to have seen a therapist in relation to the rape than the two other groups (x2 [1, n 5 99] 5 8.41; p # .005, w 5 2.32).

Most respondents reported that they would be interested in using friend-, family-, or partner-focused services, if such were provided at the CRV. Table 6 shows how many of the respondents would be interested in three potential intervention types. Respondents were particularly interested in receiving education about how best to support a rape victim, followed by having private sessions with a psychologist and meeting with friends, partners, and family members of other rape victims. Female significant others were significantly more interested than men in seeing one of the psychologists at the CRV (t 5 0.21, p # .05) and family members were more interested in seeing a psychologist than were friends (M 5 2.77, SD 5 1.19 vs. M 5 1.73, SD 5 1.03; p # .001). Those who reported a higher need for help were significantly more interested in seeing one of the psychologists at the CRV (r 5 .68, p # .005) and those who scored higher on the HTQ were significantly more interested in all three intervention types (all rs $ .24, all ps # .05).

DISCUSSION

As would be expected, most respondents blamed the perpetrator for the rape. Although it has been suggested that particularly fathers and husbands experience guilt related to not having been able to prevent the rape, we found no significant gender difference in the amount of blame the participants attributed to themselves. Furthermore, in contrast to our hypothesis and to findings by Ahrens and Campbell (2000), males attributed no more blame to the PV than females. This difference is likely because only the significant others whom the PV nominated were invited to participate in this study. It is likely that this has reduced the number of secondary victims who blame the PV for the assault as compared to the general population. In contrast, friends were significantly more likely than family members to blame the PV for the rape. Overall, however, only very little responsibility for the rape was attributed to the PV. Respondents tended to blame themselves slightly more than the PV for the assault and more than half had recurrent thoughts about having been able to prevent the rape.

Although all respondents made an effort to help and support the PV, the majority (77%) found it difficult to do so-mostly because they were unsure about how best to show their support. In contrast to our hypothesis and the findings by Ahrens and Campbell (2000) and Banyard et al. (2010), we did not find that males found it more difficult to help and that they experience their help to be less effective than did females. The reason for this may be that both of the other studies have used college samples. It is possible that a greater level of maturity in this study, as well as the fact that all respondents were selected by the PVs, decrease the insecurity in the male part of the sample. In accordance with the results of Banyard et al. (2010), we found that the respondents were generally satisfied with their abilities to support the PVs.

In accordance with prior studies and further emphasizing the idea of rape as a shared crisis, we found that about half the respondents had experienced problems in their relationship with the PV. Relationship problems of a communicative nature were particularly common but also problems related to how the PV copes with the assault were reported by about a quarter of those, who experienced problems. In accordance with previous studies, we found that overprotective behavior toward the PV was frequently reported. In contrast to our hypothesis, we did not find men to be more overprotective than women. The idea that males are more overprotective toward the PV than females has often been expressed (e.g., Ahrens & Campbell, 2000; Banyard et al., 2010); but to our knowledge, this is the first study that has actually tested the hypothesis. Therefore, it is interesting that no gender difference was found when participants were asked specifically about overprotective behavior. It is a possibility, though, which has not been examined in this study, that males and females differ in the type of overprotective behavior they express toward the PV. Furthermore, we did find that partners were more overprotective than friends-but not significantly more so than family members. Overprotective behavior from friends, family, and partners may increase avoidance on the part of the PV and lead to maintenance of symptomatology. Furthermore, it may be experienced as a burden by the PV who is struggling to regain control after the rape. More than three quarters of the respondents reported at least some overprotective behavior, but only about half the respondents reported having experienced problems in their relationship with the PV. This suggests that either overprotective behavior did not cause problems in most relationships or that many of the respondents who admitted to being at least somewhat overprotective were not aware of any restraint felt by the PV as a result of their behavior.

As previously mentioned, sexual problems are often prevalent following rape. We did not specifically assess sexual problems in this study because we did not focus specifically on partners of rape victims. However, we did find some support for the hypothesis that rape may be particularly hard on romantic relationships, as 71% of partners reported problems in their relationship with the PV and 57% reported that the relationship had gotten worse (at least temporarily) as a result of the rape. Although these numbers are higher than the equivalent percentages for family and friends, the differences were not significant. However, it is important to note that only 7% of the participants in this study were male, which reduces the power of such analyses and, thus, the results should be interpreted with caution. Even so, in most cases, negative changes in the relationship were of a temporary character, and 14% of the partners and 29% of the overall sample actually reported that their relationship with the PV had become closer following the rape. The possibility that some relationships may actually be strengthened by dealing with a sexual assault is interesting. It should be noted, however, that in average, participants filled out the questionnaire more than 4 months after the assault and in light of the finding that many romantic relationships fall apart in the aftermath of rape (Orzek, 1983). It is possible that several romantic relationships had already ended and that this is part of the reason for the relatively low number of romantic partners included in the study. Therefore, it must be up to future studies to further examine both the prevalence of and the variables associated with negative as well as positive changes in romantic relationships in the aftermath of rape, as well as changes in relationships with friends and family. This is particularly important in relation to the huge amount of clinical work that is put into helping rape victims and their loved ones deal with the assault and the impact it has on their relationship.

On top of the challenging task of supporting and caring for the PV and having to deal with the relationship being affected by the assault, many victims had to deal with their own posttraumatic symptoms. We expected to find that a substantial proportion of the secondary victims reported clinically significant levels of PTSD, and in accordance with this hypothesis, it was estimated that about one quarter of the sample suffered from PTSD. Particularly re-experiencing and increased arousal were widely experienced by the sample which resulted in a further 36% suffering from subclinical PTSD, falling just one avoidance or arousal symptom short of a full diagnosis. The relatively low prevalence of avoidance in the sample is probable linked to the finding that all participants made an effort to support the PV, which appears incompatible with most avoidance behaviors. The questionnaire used to assess PTSD symptomatology in this study does not include the A2 criterion, and therefore, the reported PTSD prevalence is only an estimate. However, shock and feelings of helplessness/hopelessness were among the most frequently reported reactions to first being confronted with the rape, suggesting that being confronted with the rape of a loved one can indeed meet the DSM-IV A2 criterion for a PTSD diagnosis. Furthermore, it should be noted that as one third of the sample were sent the questionnaire within the first month following the assault, they may not meet the 1-month duration criterion for a PTSD diagnosis. However, we argue that there is reason to believe that a substantial proportion of secondary victims of rape are so affected by learning about the sexual assault of a loved one that they develop PTSD. In contrast to the findings by Ahrens and Campbell (2000), we did not find that friends were significantly less affected by the rape than were family members or partners. More surprisingly, we did not find women to be significantly more traumatized than men, which is in contrast to the well-established gender difference in the PTSD literature as well as to the findings by Banyard et al. (2010). Again, the reason for this unexpected finding may be found in the unique sample used in this study with only people very close to the PV being included. More research on secondary victims of rape is needed to further examine gender differences, as well as differences depending on relationship with the PV.

The amount of time that had passed since the assault, efforts made to support the PV, thoughts about having been able to prevent the assault, positive support given to the respondent, and feeling let down by others at the time of the study were all significantly related to PTSD severity after all other variables were controlled for. The fact that support efforts appear to be more important than support difficulties in relation to PTSD may appear contraintuitive. However, we believe that a stronger effort to support the PV is related to more PTSD symptoms because it reflects a closer relationship with the PV as well as a stronger investment in his/her welfare. Furthermore, supporting a rape victim may be demanding for the support provider, regardless of whether he/she finds it difficult. In contrast, support given to the respondents by others served as a protective factor, whereas feeling let down by others increased PTSD severity, suggesting that professionals and others should focus not only on supporting the PV of rape but also on supporting his/her significant others. Thoughts about having been able to prevent the rape may reflect rumination about the event, which has been shown in other trauma studies to be related to higher levels of traumatization (Ehlers, Mayou, & Bryant, 1998; Ehlers, Mayou, & Bryant, 2003; Ehring, Frank, & Ehlers, 2008). It is important to note that because of the cross-sectional nature of this study, these variables should not be uncritically interpreted as risk factors for PTSD in secondary victims of rape. For example, feeling let down by others is likely to increase symptomatology, but at the same time, the presence of PTSD symptoms are also likely to affect the presence and interpretation of support from others.

The impact of rape on family, partners, and friends of the PV is further supported by the fact that most of the respondents reported that they had needed help to deal with the assault. There was a general interest in friend-, family-, and partner-focused interventions at the CRV. In accordance with the high degree of uncertainty about how best to support the PV, the interest in receiving education for significant others of rape victims was particularly high. Interest in these intervention types was significantly associated with degree of traumatization, suggesting that such initiatives may be particularly popular among those who need them the most. Interventions for significant others may not only be important in relation to treating the secondary victims of rape but may also improve the relationship between secondary and PVs, which may further help reduce the distress suffered by the PV, as it may help reduce negative social reactions and avoidance coping. Both of which have shown to be related to higher levels of PTSD in PVs (Ullman, Townsend, Filipas, & Starzynski, 2007). Although this study shows that partners are no more traumatized than other secondary victims of rape, the possibility of a positive treatment effect on the relationship to the PV may be particularly important for partners of rape victims, as romantic relationships appear to be more vulnerable to the damaging effects of rape than the relationship with family or friends. The fact that there was a general interest in the types of interventions suggested here, and that this interest was highest for those who appear to need them the most, is promising. It is up to future studies to examine, whether secondary victims of rape will actually make use of such interventions, if offered, and whether interventions such as the ones suggested here can decrease the damaging effects of rape on the secondary victim, the PV, and their relationship with each other.

Limitations

Participants in this study were all related to a PV who sought help at the CRV. This excludes significant others of victims who for some reason have failed to seek help or who have sought it elsewhere. Also, as previously noted, some of the PVs who were very affected by the assault were not asked to nominate significant others for participation in this study. Furthermore, it is likely that the friends, partners, and family members selected by the PVs to be contacted in relation to this study are not representative of the general support network of that person. For example, the PVs may have decided not to give information on significant others who were particularly stressed by the assault or on people by whom they felt let down. On top of this, there is an initial selection to whom the PV decides to tell about the assault. Finally, in general, about 99% of the victims who seek help at the CRV are females. However, in this study, the PV was male in 8% of the cases, suggesting that friends and relatives of male PVs are relatively better presented in this study than in the CRV clientele. All these conditions limit how representative the sample used for this study is of secondary rape victims in general.

Finally, it is a major limitation of the study that we did not examine sexual traumatization in the participants. The sexual assault experiences of secondary victims have been shown to affect how they respond toward the PV (Ahrens & Campbell, 2000; Banyard et al., 2010) and are likely to influence participants' own degree of traumatization in relation to disclosure. Also, rape myths have been shown to be important to how others respond to rape disclosure (Banyard et al., 2010), but the impact of such preexisting ideas of what constitutes a rape on the support given to the PV, the impact on participants' relationship with the PV, and traumatization was not examined in this study.

The cross-sectional design of this study represents a limitation to the conclusions that can be drawn based on the present findings. To the best of our knowledge, no prospective longitudinal studies have been carried out that examine the impact of sexual assault on secondary victims of rape. Such studies are needed to shed more light on risk factors of traumatization and to better estimate the prevalence of PTSD in people who are confronted with the rape of a loved one. Finally, because of the assurance of anonymity, it was not possible in this study to compare distress levels of the PV to those of the participants. The relationship between the distress suffered by the PV and the distress levels of his/her significant others is an important area for future studies to examine further. This study has shown that secondary traumatization is not just present in the male partners of female rape victims but that parents, sisters, brothers, and friends are also affected when a loved one is raped. Therefore, researchers should include these groups in future studies on secondary victims of rape.

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