The author(s) shown below used Federal funds provided by the U.S. 

Department of Justice and prepared the following final report: 

Document Title: Sexual Assault Among Intimates: Frequency,

Consequences and Treatments 

Author(s): Dr. Judith McFarlane, Dr. Ann Malecha 

Document No.: 211678 

Date Received: October 2005 

Award Number: 2002-WG-BX-0003 

This report has not been published by the U.S. Department of Justice. 

To provide better customer service, NCJRS has made this Federallyfunded grant final report available electronically in addition to

traditional paper copies.

 

Opinions or points of view expressed are those 

of the author(s) and do not necessarily reflect 

the official position or policies of the U.S. 

Department of Justice.
SEXUAL ASSAULT AMONG INTIMATES: 

FREQUENCY, CONSEQUENCES & TREATMENTS 

Grant No. 2002-WG-BX-0003 

ABSTRACT 

Dr. Judith McFarlane, Principal Investigator 

Dr. Ann Malecha, Co-Principal Investigator 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
2

RESEARCH GOAL & OBJECTIVES 

 Intimate partner sexual assault is common, outnumbering both stranger and acquaintance 

sexual assault, with 14% to 25% of women reporting sexual assault by their intimate partners at 

some time during the relationship. Although much information exists on the health and 

emotional effects of intimate partner physical abuse, little to no information is available on 

intimate partner sexual assault. The goal of this research is to describe the frequency and 

consequences of sexual assault within intimate relationships, specific to ethnicity and 

immigration status, and compare the findings to a similar group of physically abused women 

who have not experienced intimate partner sexual assault. Research objectives include a 

description of the type and frequency of sexual assault, consequences of sexual assault on 

women’s health and their children’s functioning, and treatments used by women to end the 

sexual assault. 

RESEARCH DESIGN & METHODOLOGY 

 

 A longitudinal cohort design was used. The sample of sexually assaulted and not-sexually 

assaulted women was derived from a National Institute of Justice study about protection orders. 

Among the 150 women participating in the protection order study, 148 were living two years 

later and signed informed consent to participate in this study on sexual assault. Sexual assault 

was defined as forced vaginal, oral, or anal sex. A structured interview and scored instruments 

were administered to the 148 women. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
3

RESEARCH RESULTS 

• 68% of physically abused women also reported sexual assault. 

• 79% of sexually assaulted women reported repeated episodes of forced sex, with the 

frequency of sexual assault highest for white women. 

• 6% of sexually assaulted women contacted the police following the 1st sexual assault and 

8% applied for a protection order. 

• Justice contact, either police or protection orders, was associated with up to a 70% 

reduction in the risk of re-assault. 

• Not contacting the police after the 1st sexual assault doubled a woman’s risk of re-assault 

and not applying for a protection order tripled her re-assault risk. 

• Following sexual assault, 27% of the women began or increased their use of alcohol, 

illicit drugs (usually cocaine), or nicotine use, 20% became pregnant, and 15% contracted 

a sexually transmitted disease 

• 22% of sexually assaulted women reported suicide threats or attempts within 90 days of 

applying for a protection order, compared to 4% of physically-abused only women. 

• Sexually assaulted women reported more risk factors of femicide, especially 

strangulation and threats from the abuser to kill the woman and hurt the children, 

compared to physically-abused only women. 

• 88% of the children were exposed to the violence against their mothers, with 64% of the 

children witness to the abuse by age three. Only 30% of the children received counseling. 

• Children of sexually abused mothers, age 12 to 18, showed the same degree of depressive 

behaviors as children under treatment for depression, and appreciably more behavioral 

problems than youngsters of physically-abused only mothers. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
4

RESEARCH CONCLUSIONS 

Justice, health, and social service professionals assisting abused women should routinely: 

• Receive training about the frequency, health and safety consequences of intimate partner 

sexual assault. 

• Assess for type and frequency of sexual assault. 

• Inform women reporting sexual assault about their increased risk of femicide, posttraumatic stress disorder, substance use, and suicide, followed with appropriate referrals 

and safety planning information. 

• Offer information about symptoms of post-traumatic stress disorder and suicidal ideation, 

as well as referral agencies for treatment. 

• Inform pregnant women of the increased risk of femicide to women physically or 

sexually assaulted during pregnancy, followed with appropriate referrals and safety 

planning information. 

• Inform mothers of the potential negative effects of domestic violence on their child’s 

behavior, followed with appropriate referrals. 

• Inform immigrant women of the increased risk of post-traumatic stress among non-US 

born women, followed with culturally appropriate referrals and safety planning 

information. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
SEXUAL ASSAULT AMONG INTIMATES: 

FREQUENCY, CONSEQUENCES & TREATMENTS 

Grant No. 2002-WG-BX-0003 

EXECUTIVE SUMMARY 

Dr. Judith McFarlane, Principal Investigator 

Dr. Ann Malecha, Co-Principal Investigator 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
2

RESEARCH PURPOSE & OBJECTIVES 

 Intimate partner sexual assault is common, outnumbering both stranger and acquaintance 

sexual assault, with 14% to 25% of women reporting sexual assault by their intimate partners at 

some time during the relationship (Bennice & Resick, 2003). Although much information exists 

on the health and emotional effects of intimate partner physical abuse, little to no information is 

available on intimate partner sexual assault. The purpose of this study is to describe the 

frequency and consequences of sexual assault within abusive intimate relationships, specific to 

ethnicity and immigrant status, and compare the findings to a similar group of physically abused 

women who have not experienced intimate partner sexual assault. Research objectives include a 

description of the type, extent, and temporal sequencing of sexual assault, consequences of 

sexual assault on women’s health and their children’s functioning, and treatments used by 

women to end the sexual assault. 

RESEARCH SETTING & SAMPLE 

 The sample of sexually assaulted and not-sexually assaulted women was derived from a 

National Institute of Justice study that measured the effectiveness of protection orders and tested 

a safety intervention for abused women, the results of which are published (McFarlane, et al., 

2002(a), 2002(b), 2004(a), 2004(b); Malecha, et al., 2003). Among the 150 women participating 

in the protection order study, which took place at the Houston District Attorney’s Office, 148 

women signed informed consent to participate in the sexual assault study. 

RESARCH METHODS

 Sexual assault was defined as a positive response to questions about forced vaginal, oral, 

or anal sex as asked on the Severity of Violence against Women, Sexual Assault Subscale 

(Marshall, 1987). A structured interview asked about type, frequency, sequencing, 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
3

circumstances, and perpetrator behaviors at the time of the first and subsequent sexual assaults as 

well as actions the woman took to end the sexual assault. Questionnaires were used to measure 

extent of violence, physical and mental health, and social support for both sexually assaulted and 

not-sexually assaulted women. Specific questionnaires included the Danger Assessment Scale, 

which measures risk for femicide, and the Severity of Violence Against Women Scales which 

measure the frequency and severity of threats of abuse and physical assault. Stalking and work 

harassment surveys were also used. The Brief Symptom Inventory and the Post Traumatic Stress 

Disorder Scale assessed mental health functioning, and dimensions of social support were 

measured with the Medical Outcomes Study Social Support Survey. Additionally, sexual 

decision-making practices were asked of both groups of women. Finally, aggressive and 

depressive behaviors of children of sexually assaulted mothers were compared to behaviors of 

children of physically assaulted only mothers using the Child Behavior Checklist questionnaire. 

A mixed-model analysis plan tested for significant between-group differences for women 

reporting sexual assault, compared to women not reporting sexual assault, as well as withingroup difference according to racial and ethnic self-identification and immigrant status. The 

results of this study can be generalized to an African-American, Hispanic and White urban 

population of women applying for a protection order against an intimate partner. Limitations to 

the study include a small sample size and self-reported data, which may under or over report the 

information. 

RESEARCH RESULTS 

Demographic Characteristics of the Women

 Among this group of 148 women, 33% self-identified as African American, 26% 

identified as White and 41% considered themselves Hispanic. Twenty eight percent of the 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
4

women were first generation immigrants, primarily from Mexico, and 26% of the women were 

non-English speaking. One hundred women (68%) reported sexual assault, at least once, by the 

intimate partner named in application for a protection order. Among the 100 women reporting 

sexual assault, most of the women, 62%, reported an event of sexual assault within 90 days of 

applying for the protection order. There was no significant demographic differences between 

women reporting sexually assault and women reporting physical abuse only. Both groups 

consisted of equal proportions of African-American, White and Hispanic women as well as nonUS-born women and non-English speakers. Over 75% of the women in each group reported 

employment, with a reported income of less than $20,000. 

Type and Frequency of Sexual Assault

 Most women (79%) reported repeated episodes of sexual assault, including vaginal, oral 

and anal penetration, with forced vaginal intercourse accounting for the highest percentage of 

sexual assault. Over half (55%) of the women reported a second sexual assault within one month 

of the first assault. The frequency of sexual assault was highest for white women. However, the 

type, frequency and severity of sexual assault did not differ significantly by racial or ethnic 

group or country of birth. 

Sequencing of Consensual Sex, Sexual Assault and Application for a Protective Order

 Over half of the women (52%) were sexually assaulted by their intimate partner for the 

first time within two years after the first consensual sex. Most women waited several years after 

the first sexual assault before applying for a protection order, with white women waiting the 

longest (on average 8 years) followed by Hispanic women (on average 5 years) and African 

American women who waited the shortest length of time, (on average 3 years). For 30% of the 

women, sexual assault occurred before the physical abuse began. Several women reported the 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
5

physical abuse began when they began to physically resist the sexual abuse. As one woman 

explained, “When I began to resist the forced sex by kicking and pushing him away, he became 

more violent and starting hitting, punching and holding me down for sex”.

Relationship Circumstances around the Time of the First Sexual Assault

 Most women (83%) reported a change in the relationship before the first sexual assault, 

with 33% of the women reporting the abuser had become more violent, possessive, or 

controlling. Twenty-two percent of the women reported an “emotional” separation prior to the 

first sexual assault. Examples of an “emotional separation” included statements of “we did not 

talk to each other anymore”, “I didn’t want to be with him anymore and he knew it”. Seventeen 

percent of the women reported an actual, or pending, physical separation of the couple prior to 

the first sexual assault, and 15% of the women reported the abuser had begun to use illicit drugs 

or alcohol before the first assault. When illicit drug use was reported, the drug reported was 

usually cocaine. 

Perpetrator Behaviors Immediately Before and After the First & Subsequent Sexual Assaults

 Over 50% of abusers used alcohol during the first and subsequent sexual assaults, and 

40% used illicit drugs, with 60% of the illicit drugs reported as crack or cocaine. Forty percent of 

the women were physically assaulted immediately before the first sexual assault and almost 50% 

were physically assaulted before future sexual assaults. Thirty percent of the women were 

physically assaulted immediately after the first sexual assault and 35% were physically assaulted 

immediately following future sexual assaults. 

Victim Helpseeking after the First and Additional Sexual Assaults

 The women sought help in a variety of ways. The most common person with whom the 

women shared the sexual assault was a friend or family member. Women who sought help from 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
6

the justice system, either by contacting the police or applying for a protection order, after the first 

sexual assault were significantly less likely to be re-assaulted. Women who contacted the police 

after the first assault, irrespective of whether or not the abuser was arrested, were 59% less likely 

to be re-assaulted. Women who applied for a protection order after the first assault, irrespective 

of whether or not the order was received, were 70% less likely to be re-assaulted. Stated another 

way, women who did not contact the police after the first sexual abuse were 2.4 times more 

likely to be re-assaulted, and women who did not apply for a protection order were 3.3 times 

more likely to be re-assaulted. 

 Helpseeking behavior was repeated. Women who told someone about the sexual assault 

after the first occurrence were 2.5 times more likely to tell someone after subsequent sexual 

assaults. Women who contacted the police after the first sexual assault were 7.7 times more 

likely to contact the police after re-assaults. Women who received medical care after the first 

assault were 8.3 times more likely to receive medical care after re-assaults. However, none of the 

women who applied for a protection order after the first sexual assault applied after re-assaults. 

Likewise, none of the women who received counseling after the first sexual assault went for 

counseling after re-assaults. Further research is needed to understand why protection orders and 

counseling were not sought following re-assaults. 

Outcomes of Sexually Assaulted Women’s Contact with Justice Agencies

 Outcomes following the woman’s contact with the justice system varied from the first to 

second sexual assault. Among the women who contacted the police following the first sexual 

assault, half of the abusers were arrested. Similarly, 50% of the women seeking a protection 

order after the first sexual assault received the order. However, among the women contacting the 

police following the second sexual assault, only 20% of the abusers were arrested; however, twoThis document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
7

thirds of the women applying for a protection order received the order. Arrest was higher 

following police contact for the first sexual assault but more protection orders were received 

following the second sexual assault. 

Consequences of Intimate Partner Sexual Assault on Women’s Safety & Health

 Compared to not-sexually assaulted women, the sexually abused women reported 

significantly more risk factors of femicide (see Figure 1), more episodes of work harassment, and 

worse physical and mental health functioning. These findings did not vary significantly by racial 

or ethnic group or country of birth. Risk factors for femicide were highest for African-American 

women, followed by White women. Hispanic women reported the lowest number of risk factors. 

However, episodes of work harassment were highest for White women followed by AfricanAmerican women. Alarming is the fact that 22% of the sexually assaulted women had threatened 

or tried to commit suicide within 90 days of applying for a protection order compared to only 4% 

of the not-sexually assaulted women. 

 Twenty-four months after contacting the justice system for a protection order, sexually 

abused women reported significantly more symptoms of post-traumatic stress disorder compared 

to not-sexually abused women, regardless of racial/ethnic group or country of birth (see Figure 

2). Hispanic and immigrant women reported the most symptoms of post-traumatic stress 

disorder, and immigrant women reported significantly fewer sources of social support. 

Health Problems the Women Attribute to Intimate Partner Sexual Assault

 Vaginal and rectal bleeding, sexually transmitted diseases and pelvic inflammatory 

disease were reported significantly more often by women experiencing repeated sexual assaults. 

One-third of women who reported repeated sexual assaults also reported beginning or increasing 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
8

use of alcohol, nicotine, or illicit drugs, usually cocaine, because of the sexual assaults, with 27% 

of the women reporting alcohol use beginning or increasing because of the forced sex. 

Rape-Related Pregnancy

 Twenty-percent of the women reported at least one rape-related pregnancy. Almost onefifth (16%) of the rape-related pregnancies were ended with an elective abortion. Thirty-percent 

of the women reported sexual assault during pregnancy. 

Sexual Decision Making and Intimate Partner Sexual Assault

 When asked about mutual decision making and sexual relations, women sexually 

assaulted reported their intimate partner was significantly less likely to participate in mutual 

decision making, compared to partners of women not reporting sexual assault. Sexually 

assaulted women wanted to use condoms to prevent sexually transmitted diseases significantly 

more often than not-sexually assaulted women. More than one-fourth (26%) of the sexually 

assaulted women became pregnant because the abuser would not use birth control compared to 

only 5% of the women not-sexually assaulted. 

Why some women were physically but never sexually assaulted? 

 Women physically but not sexually assaulted were asked if they had ever worried about 

sexual assault. Among the 48 women never sexually assaulted, 8 women (17%) reported being 

worried about forced sex. Seven of the women who had worried about the possibility of forced 

sex reported changes in the relationship, such as a separation, pregnancy, or an increase in 

physical abuse. Only three women discussed this worry of a possible sexual assault with 

someone, primarily family or friends. Among the women that reported they never worried about 

forced sex, 85% stated the abuser always took “no” to sexual intercourse as an absolute answer. 

The remaining 15% of the women stated the abuser went elsewhere for sex if they said “no”. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
9

Child Witness to Intimate Partner Physical or Sexual Assault and Counseling Received

 Most of the women (77%) had one or more children. When asked if any of their children 

had ever seen or heard the physical or sexual assault, 88% of the women answered “yes”. A total 

of 205 children were reported to have been exposed to the assault of their mother, with more than 

one-third of the children (36%) exposed to the violence for the first time during infancy, and 

64% exposed by age three. Only one-third of the children had received counseling. When asked 

how helpful the counseling was, 82% of the mothers rated the counseling as “very helpful”, or 

“somewhat helpful”. 

Behaviors of Children Exposed and Not-Exposed to Intimate Partner Sexual Assault

 When the behaviors of children of sexually abused mothers were compared to youngsters 

of physically abused only mothers, youngsters age 12-18 showed more depression. These same 

youngsters had behavior problems consistent with children being treated in a clinical setting and 

appreciably more problems than youngsters of physically-abused-only mothers. 

RESEARCH RESULTS SUMMARY 

• 68% of physically abused women also reported sexual assault. 

• 79% of sexually assaulted women reported repeated episodes of forced sex with the 

frequency of sexual assault highest for white women. 

• 6% of sexually assaulted women contacted the police following the 1st sexual assault and 

8% applied for a protection order. 

• Justice contact, either police or protection orders, was associated with up to a 70% 

reduction in the risk of re-assault. 

• Not contacting the police after the 1st sexual assault doubled a woman’s risk of re-assault 

and not applying for a protection order tripled her re-assault risk. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
10

• Following sexual assault 27% of the women began or increased their use of alcohol, 

illicit drugs (usually cocaine), or nicotine use, 20% became pregnant, and 15% contracted 

a sexually transmitted disease 

• 22% of sexually assaulted women reported suicide threats or attempts within 90 days of 

applying for a protection order, compared to 4% of physically-abused only women. 

• Sexually assaulted women reported more risk factors of femicide, especially 

strangulation and threats from the abuser to kill the woman and hurt the children, 

compared to physically-abused only women. 

• 88% of the children were exposed to the violence against their mothers, with 64% of the 

children witness to the abuse by age three. Only 30% of the children received counseling. 

• Children of sexually-abused mothers, age 12 to 18, showed the same degree of depressive 

behaviors as children under treatment, and appreciably more problems than youngsters of 

physically-abused only mothers. 

RESEARCH CONCLUSIONS

 In this study intimate partner sexual assault was common, reported by 68% of the women 

applying for a protection order, and equally experienced by African-American, Hispanic, White, 

US-born and immigrant women. Sexually assaulted women reported an increased risk of 

femicide, rape-related pregnancy, poor physical and mental health, post-traumatic stress disorder, 

increased alcohol use, and suicide. By age three most of the children of women in this study had 

witnessed the physical and/or sexual assault of their mothers. Many of the children had 

behavioral disorders and most had never received counseling. The women who reported contact 

with the justice system, either law enforcement or protection orders, experienced a decrease in 

the risk of re-assault. Our findings indicate the need for accessible and acceptable justice, health, 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
11

and social services agencies for women experiencing sexual assault, as well as justice, health and 

social service personnel trained in the frequency, health and safety consequences of intimate 

partner sexual assault.

RESEARCH RECOMMENDATIONS 

Justice, health, and social service professionals assisting abused women should routinely: 

• Receive training about the frequency, health and safety consequences of intimate partner 

sexual assault. 

• Assess for type and frequency of sexual assault. 

• Inform women reporting sexual assault about their increased risk of femicide, posttraumatic stress disorder, substance use, and suicide, followed with appropriate referrals 

and safety planning information. 

• Offer information about symptoms of post-traumatic stress disorder and suicidal ideation, 

as well as referral agencies for treatment. 

• Inform pregnant women of the increased risk of femicide to women physically or 

sexually assaulted during pregnancy, followed with appropriate referrals and safety 

planning information. 

• Inform mothers of the potential negative effects of domestic violence on their child’s 

behavior, followed with appropriate referrals. 

• Inform immigrant women of the increased risk of post-traumatic stress among non-US 

born women, followed with culturally appropriate referrals and safety planning 

information.

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
12

References: 

Bennice, J.A., & Resick, P.A.(2003). Marital Rape History, Research, and Practice. Trauma, 

 Violence, & Abuse. 4(3): 228-246. 

McFarlane, J., Malecha, A., Gist, J., Watson, K., Batten, E., Hall, I., & Smith, S. (2002a). An 

 intervention to increase safety behaviors of abused women: Results of a randomized 

 clinical trial. Journal of Nursing Research. 51(6): 347-354. 

McFarlane, J., Malecha, A., Gist, J., Watson, K., Batten, E., Hall, I., & Smith, S. (2002b) 

 Intimate partner violence against immigrant women: Measuring the effectiveness of 

 protection orders. American Journal of Family Law. 16(4): 244-252. 

McFarlane, J., Malecha, A., Gist, J., Watson, K., Batten, E., Hall, I., & Smith, S. (2004a). A 

 Nursing Intervention to Increase Safety Behaviors of Abused Women That Remains 

 Effective for 18 Months. American Journal of Nursing. 104(3): 40-50. 

McFarlane, J., Malecha, A., Gist, J., Watson, K., Batten, E., Hall, I., & Smith, S. (2004b). 

 Protection Orders and Intimate Partner Violence? An analysis of 150 Black, White and 

 Hispanic women. American Journal of Public Health. 94(4): 613-618. 

Malecha, A., McFarlane, J., Gist, J., Watson, K. ., Batten, E., Hall, I., & Smith, S Appling for 

 and Dropping a protection order: A study with 150 Black, Hispanic and White women. 

Criminal Justice Policy & Review . 14(4): 486-504. 

Marshall, L. (1992). Development of the severity of violence against women scales. Journal of 

 Family Violence, 7(2): 103-121. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
13

Figure 1. Frequency of Risk Factors for Femicide Reported by Sexually Assaulted (n=100) and 

Not-Sexually Assaulted (n=48) Women 

0

10

20

30

40

50

60

70

80

90

Abuse Increase

Abuse Worse

Woman Choked

Gun in house

Abuser on drugs

Abuser threats to kill woman

Abuser drunk daily

Abuser controlling

If pregnant, woman beaten

Abuser jealous

Abuser threats suicide

Abuser violent outside home

Abuser has a gun

Abuser threats to hurt children

Woman threats suicide

Perc

e

nt

No Sexual Assault Sexual Assault

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
14

Figure 2. Frequency of Symptoms of Posttraumatic Stress Disorder Reported by Sexually 

Assaulted (n=100) and Not-Sexually Assaulted (n=48) Women 

0

10

20

30

40

50

60

70

80

90

100

Avoid talk about abuse

Disinterest in

life

Felt cut off from others

Felt numb

Changed future plans

Sleeplessness

Jumpy

Percent

No Sexual Assult Sexual Assault

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
SEXUAL ASSAULT AMONG INTIMATES: 

FREQUENCY, CONSEQUENCES & TREATMENTS 

Grant No. 2002-WG-BX-0003 

September 1, 2002 to August 31, 2004 

TECHNICAL REPORT 

Dr. Judith McFarlane, Principal Investigator 

Dr. Ann Malecha, Co-Principal Investigator 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
TABLE OF CONTENTS PAGE

RESEARCH PURPOSE & OBJECTIVES .......................................... 2 

METHODS ................................................................................ 3 

INSTRUMENTS 4 

• Demographic Data Form ...................................................... 4 

• Brief Symptom Inventory .................................................... 4 

• Post Traumatic Stress Disorder Scale ...................................... 5 

• Family Hardiness Scale ...................................................... 5 

• Medical Outcomes Study Social Support Survey........................ 6 

• Child Behavior Checklist ................................................... 6 

• Severity of Violence Against Women Scales.............................. 7 

• Stalking Victimization Survey .............................................. 8 

• Danger Assessment Scale ................................................... 8 

• Worksite Harassment ........................................................ 8 

• Medical Outcomes Study Short Form (SF-12) Health Survey.......... 9 

DATA ANALYSIS .................................................................. 9 

RESULTS ............................................................................ 11 

Demographics of Sexually Assaulted & Not-Sexually Assaulted ............. 11 

Characteristics of Intimate Partner Sexual Assault .............................. 12 

• Type & Frequency of Sexual Assaults ................................... 12 

• Temporal Sequencing of Sexual Assaults .............................. 12 

• Relationship Circumstances & the First Assault ........................ 13 

• Perpetrator Behaviors Immediately Before & After Sexual Assaults . 14 

• Helpseeking Behaviors After the First & Subsequent Sexual Assaults .. 14 

Consequences of Sexual Assault for Women’s Health & Safety 16 

• Violence & Health at Time of Application for a Protection Order 16 

• Psychological Measures Two Years after Application for a Protection Order .. 17 

• Health Problems Attributed to Sexual Assault .......................... 18 

• Sexual Assault & Suicidality ................................................ 19 

• Rape-Related Pregnancy ....................................................... 19 

• Sexual Decision Making & Sexual Assault ................................. 19 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Consequences of Intimate Partner Sexual Assault on Children 20 

• Child Witness to Sexual Assault & Counseling Received .................. 20 

• Behaviors of Children Exposed & Not-exposed to Sexual Assault ........ 20 

Women Who Were Physically but Not Sexually Assaulted ......................... 21 

Social & Family Functioning of Sexually & Not-Sexually Assaulted Women ... 21 

RESULTS SUMMARY .................................................................. 22 

DISCUSSION OF RESEARCH FINDINGS 23 

• Characteristics of the Sexual Assault Event .................................. 23 

• Helpseeking Following Sexual Assault ...................................... 24 

• Risk of Re-Assault After Helpseeking with Justice Agencies ....... 25 

• Consequences of Sexual Assault on Women’s Physical Health 27 

1) Gynecological Problems ............................................. 27 

2) Sexually Transmitted Diseases ...................................... 28 

3) Rape-Related Pregnancy ............................................ 29 

4) Ill Health during Pregnancy & Poor Pregnancy Outcomes .... 30 

5) Elective Abortion ..................................................... 30 

• Consequences of Sexual Assault on Women’s Mental Health 31 

1) Alcohol, Illicit drug & Nicotine Use .............................. 32 

2) Depression ............................................................ 33 

3) Post Traumatic Stress Disorder .................................... 34 

4) Suicidality ............................................................ 37 

5) Femicide ............................................................... 39 

• Consequences of Mothers Assault on Children’s Behavior 39 

STUDY CONCLUSIONS 40 

STUDY LIMITATIONS ............................................................... 42 

STUDY IMPLICATIONS FOR HEALTH & JUSTICE PRACTICE .......... 43 

STUDY RECOMMENDATIONS .................................................... 44 

EXHIBITS 1- 24 ......................................................................... 46 

Biographical Sketches of Investigators ............................................... 70 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 

 

 

SEXUAL ASSAULT AMONG INTIMATES: 

FREQUENCY, CONSEQUENCES & TREATMENTS 

Grant No. 2002-WG-BX-0003 

TECHNICAL REPORT 

Dr. Judith McFarlane, Principal Investigator 

Dr. Ann Malecha, Co-Principal Investigator 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
2

INTRODUCTION 

The prevalence and health effects of intimate partner physical assault against women are 

well chronicled (Tjaden & Thoennes, 2000). Conversely, the extent and especially the 

consequences of intimate partner sexual assault are virtually unknown. Most of what is known 

about intimate partner sexual assault is from reports by physically abused women, usually 

women seeking services (Campbell & Alford, 1989; Bergen, 1996). Studies consistently report 

40% to 50% of physically abused women are also sexually assaulted (Campbell, 1989; Bergen, 

1996; Campbell & Soeken, 1999), a rate four to five times higher than the 9 to 13% reported by 

women from community and national samples (Finkelhor & Yllo, 1985; Russell, 1990; 

Kilpatrick, Edmundo, & Seymour, 1992; Basile, 2002). 

 Although intimate partner sexual assault is not exclusively found in battering 

relationships, it is nearly impossible to find a large enough sample of women to study who have 

experienced sexual violence yet have not been physically assaulted by their intimates as well. 

The time sequencing of physical and sexual assault within intimate relationship is unknown. 

Correct sequencing is essential for developing a causal model of victimization and reactions. 

Therefore, to describe the temporal sequencing, consequences and treatments sought by intimate 

partner sexual assault victims, disentangle the health effects of sexual versus physical assault, 

and make recommendations to justice and health agencies, a cohort of 150 African-American, 

Hispanic and White women who sought justice services were interviewed. 

RESEARCH PURPOSE & OBJECTIVES

The purpose of this research is to describe the frequency and consequences of sexual 

assault within intimate relationships specific to ethnicity and immigrant status and compare the 

findings to a similar group of physically-assaulted-only women. Project objectives include a 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
3

description of the type, extent, and temporal sequencing of sexual assault, consequences of 

sexual assault on women’s health, and their children’s functioning, and treatments used by 

women to end the sexual assault. Finally, recommendations for both justice and health service 

providers are presented. 

METHODS 

Our first study began in January 2001 at a special family violence unit of the Harris 

County District Attorney’s office in Houston, Texas that serves an ethnically diverse population 

of 3 million citizens. All women who presented to this special family violence unit at the district

attorney’s office to apply for a protection order and who completed the application process, 

qualified for the protection order, and met our inclusion criteria (e.g., female, 18 years or older, 

English or Spanish speaker) were invited by one of 6 investigators into a study about the 

effectiveness of protection orders. Women were invited to participate until 150 women entered 

the study. Four women refused to participate in the study. One woman committed suicide 6 

weeks into the study. All of the remaining 149 women completed the 18-month protection order 

effectiveness study, the results of which have been published (Malecha et al., 2003; McFarlane, 

et al., 2002a, 2002b; 2004a; 2004b). (For specifics on how many women received a protection 

order, reasons for not receiving an order, and outcomes, the reader is referred to the publications 

by McFarlane and her associates). 

Among the initial cohort of 150 women, 148 women were alive in January 2003 and 

signed informed consent for the second study, “Sexual assault among intimates: Frequency, 

consequences and treatments”. The second study is the focus on the present report. Sexual 

assault was defined as a positive response to any one of the five questions on the Severity of

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
4

Abuse against Women, Sexual Assault Subscale (Marshall, 1992). The five questions are: 

During the relationship, did (name of abuser) 

• Make you have sexual intercourse against your will? 

• Physically force you to have sex? 

• Make you have oral sex against your will? 

• Make you have anal sex against your will? 

• Use an object on you in a sexual way? 

Additional questions asked about type and frequency of decision making and actions 

regarding sexual relations, condom use, and birth control. A detailed history of perpetrator 

behavior at the time of the first and additional sexual assaults was obtained, as well as victim

helpseeking and health problems following the sexual assault(s). All sexual assault histories 

occurred before the victims came to the district attorney’s office in January 2001 to apply for a 

protection order. Instruments were administered to determine type and severity of violence, 

physical and mental health functioning, family hardiness, and social support functioning. All 

instruments were offered in English or Spanish according to the woman’s preference and 

completed during a personal interview in a private setting at a time and location convenient for 

the woman. All women were offered $50 at the completion of the interview. 

Instruments 

A Demographic Data Form was used to document information on the woman’s age, 

education, income, self-identified race/ethnicity, employment status, relationship to the abuser, 

and primary language. 

The Brief Symptom Inventory (BSI) is an 18-item instrument that measures three 

psychological dimensions: depression (6 items including feeling no interest in things, feeling 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
5

lonely, feeling blue, and suicidal ideation), anxiety (6 items including nervousness, tension, and 

feeling fearful), and somatization (6 items including faintness or dizziness, pains in heart or 

chest, and feeling weak). Additionally, a Global Severity Index summarizes the respondent’s 

overall level of psychological distress (Derogatis, 2001). Available in both English and Spanish, 

internal consistency reliability ranges from 0.74 to 0.89 for the subscales. Test-retest reliability 

over two weeks ranges from 0.68 to 0.91. High convergent validity exists between the subscales 

with the longer version BSI-53. A global index score of 63 or greater places the person at risk to 

psychological distress as does a score of 63 or greater or any two or the three scales. In this 

study, reliability (Cronbach alpha coefficient) was 0.88 for depression, 0.85 for anxiety, and 0.85 

for somatization. 

Post Traumatic Stress Disorder Scale (PTSD) is a 7-item symptom scale that screens for 

post traumatic stress disorder. The instrument is a short form of the modified National Institute 

of Mental Health Diagnostic Interview Schedule and the World Health Organization Composite 

International Diagnostic Interview, version 2.1 (Breslau, et al., 1999). Scores of greater than 4 

indicate post traumatic stress disorder with a sensitivity of 80% and a specificity of 97%, a 

positive predictive value of 71%, and a negative predictive value of 98%. In this study, reliability

(Cronbach alpha coefficient) was 0.78. 

Family Hardiness Index (FHI) is a 20-item instrument that measures family hardiness or 

the internal strength and durability of the family and the ability to resist stress and to adapt to and 

effectively deal with new situations (McCubbin, McCubbin & Thompson, 1991). A higher score 

indicates greater family hardiness or internal strength. The instrument has been tested on 

community samples with a reported alpha of .82 for internal consistency. In this study, reliability

(Cronbach alpha coefficient) was 0.89. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
6

The Medical Outcomes Study (MOS) Social Support Survey measures various 

dimensions of social support and includes four functional support scales: 

emotional/informational support, tangible support, affectionate support, and positive social 

interaction support (Sherbourne & Stewart, 1991). These subscales all have alphas greater than 

0.91 and are stable over time. For this study, three social support structural items (How many 

close friends do you have? How many relatives do you have that you feel close to? How many of 

these friends or relatives do you see at least once a month?) were included. Two items from each 

of the four functional support scales were also included. In this study, reliability (Cronbach alpha 

coefficient) was 0.83 for the eleven social support items. 

The Child Behavior Checklist (CBCL) is a standardized instrument that provides a 

parental report of the extent of a child’s behavioral problems and social competencies. The 

CBCL consists of a form for children 18 months to 5 years (Achenbach & Rescorla, 2000) and a 

version for ages 6 to 18 years (Achenbach & Rescorla, 1991). The CBCL is orally administered 

to a parent who rates the presence and frequency of certain behaviors on a 3-point scale (0=not 

true, 1=somewhat or sometimes true, and 2=very true or often true). The time period is the last 6 

months for the child age 6 to 18 years, or last 2 months for the child age 18 months to 5 years. 

Examples of behaviors for the child age 6-18 years include, “destroys his/her own things,” “gets 

in many fights,” “truancy, skips school”. Examples of behaviors for the child age 18 months to 5 

years include, “cruel to animals”, “physically attacks people”, and “doesn’t want to sleep alone”. 

Both forms of the CBCL consist of two broadband factors of behavioral problems: internalizing 

and externalizing with mean scale scores for national normative samples as well as clinically 

referred and non-referred samples of children. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
7

Internalizing behaviors include anxiety/depression, withdrawal and somatic complaints. 

Externalizing behaviors include attention problems, aggressive behavior, and rule-breaking 

actions. Behavioral scales yield a score of total behavioral problems. Scores are summed and 

then converted to normalized T scores. For 6 to18 year olds, T scores are age and gender 

specific. For children 18 months to 5 years, the T scores are not age or gender specific. For 

internal, external, and total behavior problems, T scores > 60 are within the borderline/clinical 

referral range - higher scores represent more deviant behavior. Reliability for children 18 

months to 5 years were 0.94, 0.91, and 0.97 for internal, external and total behavior problems, 

respectively. Reliability for youngsters 6 to 18 years in this sample were 0.89, 0.91, and 0.95 for 

internal, external and total behavior problems, respectively. 

Data from the study on effectiveness of protection orders were re-stratified to measure 

differences between sexually abused and not-sexually abused women. Instruments used in the restratified analysis included the following: 

Severity of Violence against Women Scales (SAVAWS). This 46-item instrument is 

designed to measure threats of physical violence (19 items) and physical assault (27 items) 

(Marshall, 1992). Examples of behaviors that threaten physical violence are threats to destroy 

property, do bodily harm, or harm other family members. Examples of behaviors that represent 

physical violence are kicking, choking, beating up, and engaging in forced sex. For each item,

respondents use a 3-point scale to indicate how often the behavior occurred (0=never, 1=once, 

2=2-3 times, 3=4 or more times). Possible score ranges were 0-57 for the threat of abuse scale 

and 0-81 for the physical abuse scale. The higher the score, the more violence reported. Internal 

consistency reliability estimates in studies of abused women have ranged from 0.89 to 0.91 for 

the threat of abuse scale and from 0.91 to 0.94 for the physical abuse scale (Gist, et al., 2001; 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
8

Wiist & McFarlane, 1998a, 1998b). In the present study, reliabilities (measured via Cronbach 

alpha coefficients) were 0.91 for the threat of abuse dimension and 0.94 for the physical abuse 

dimension. 

Stalking Victimization Survey. This 17-item yes/no questionnaire was used to document 

the frequency and type of stalking engaged in by the perpetrator. The initial stalking survey 

instrument consisted of 7 items (e.g., being followed or spied on, being sent unsolicited letters or 

written correspondence, or finding the perpetrator standing outside one’s home, school, or 

workplace) developed by Tjaden and Thoennes (1998). Ten items were added from the Sheridan 

(1998) HARASS instrument to form the overall 17-item instrument used here. Examples of items

added include threats by the abuser to harm the children or to commit suicide if the woman left

the relationship, leaving threatening notes on the woman’s car, and threatening her family. The 

possible score range was 0 to 17. In this study, reliability (Cronbach alpha coefficient) was 0.83. 

Danger Assessment Scale. This 15-item instrument, with a yes/no response format, was 

used to determine the woman’s potential risk of becoming a femicide victim (Campbell, 1986). 

All of the items refer to risk factors that have been associated with murder in situations involving 

abuse. Examples of risk factors include the abuser’s possession of a gun, use of drugs, and 

violent behavior outside the home. The possible score range was 0 to 15. Scale reliability 

coefficients have ranged from 0.60 to 0.86 in several studies (Campbell, 1995). In this study, the 

reliability (Cronbach’s alpha coefficient) was 0.61. 

Worksite Harassment. Eight yes/no questions were asked about worksite harassment. 

Questions were derived from a congressional report that reviewed studies of worksite harassment 

of women by intimate partners (US General Accounting Office, 1998). Questions focused on, for 

example, repeated call/visits to the woman’s worksite and difficulties experienced by the woman 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
9

in regard to going to work. The possible score range was 0 to 8. In this study reliability 

(Cronbach’s alpha coefficient) was measured as 0.63. 

Medical Outcomes Study (MOS) Short Form (SF-12) Health Survey. This 12–item

instrument, derieved from a longer version, the SF-36, was developed to measure health 

outcomes in a variety of populations (Ware, et al., 1996). The SF-12 is comprised of a physical 

health component summary and a mental health component summary. Scoring is accomplished 

by recoding items, computing scale scores, and transforming raw scores to a 0 to 100 scale. 

Internal consistency reliability is 0.89 for the physical component summary and 0.86 for the 

mental components summary (Ware, et al., 2002). Validity of the SF-12 has been established in 

diverse populations. Ware and associates established construct validity using a reference group 

technique and successfully discriminated between well groups and groups with chronic 

conditions. Available in both English and Spanish, the SF-12 can be administered in 2 minutes. 

Norm scores at the 75th percentile are 56.0 for the physical component score and 56.9 for the 

mental component score. Reliability for this study (Cronbach’s alpha coefficient) was measured 

as 0.76. 

DATA ANALYSIS 

Means, standard deviations, and frequencies are used to describe the demographic 

characteristics of the 100 women sexually and physically assaulted compared to the 48 women 

physically abused only. Chi-square analyses determined whether the groups of women differed 

significantly with respect to race/ethnicity, immigrant status, English proficiency, education, 

employment, income and relationship to the abuser. 

 Descriptive statistics document perpetrator behaviors immediately before and after the 

sexual assaults. Temporal sequencing of the physical and sexual assaults, types of helpseeking 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
10

behaviors used by the women following the sexual assault(s), and the outcome of the 

helpseeking behaviors are presented with descriptive statistics. Also described in frequency 

tables and tested with chi-square analyses are the types of sexual decision-making reported by 

the women. An extensive set of frequency tables document the type of health problems the 

sexually assaulted women attributed to the assault(s). We completed relative risk analysis to 

determine if helpseeking with justice or health agencies after the first sexual assault decreased a 

woman’s likelihood of experiencing a second sexual assault. Chi-square analyses and Fisher’s 

exact tests were used to measure group differences between women who sought and did not seek 

agency help following sexual assault.

 Univariate and multivariate analyses of variance were completed to measure ethnic and 

immigrant status effects on measures of violence, health, social functioning, and family 

hardiness. Follow-up tests were completed when a global significant difference was detected. 

To measure the children’s behavior with an adequate representation of age and gender 

strata, the older child was selected in families with more than one child between the ages of 1.5-

17 years. As internal and external behaviors were components of total behavior problems and 

they were highly correlated with total behavior problems, a multivariate design with internal and 

external behaviors and a univariate design with total behavior problems were used. Furthermore, 

different instruments were used for children between 1.5 and 5 yrs and children, 6-18 years of 

age. Therefore, separate analyses were performed for the 2 major age groups. For children aged 

1.5-5 yrs, a one-factor multivariate analysis of variance (MANOVA) was used to test for group 

differences in internal and external behaviors and adjustments were made for gender as needed. 

A one-factor analysis of variance (ANOVA) was used to test for group differences in total 

behavior problems. Similar analyses were performed for children between 6-18 yrs of age. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
11

Because of the age strata, the analyses were adjusted for age group and gender when necessary 

for this older group. The second set of analyses included one-sample t-tests to compare, for each 

age and age by gender strata, mean scores for children from sexually abused mothers to clinically 

referred and non-referred norms. 

RESULTS 

Demographic Characteristics of Sexually Abused and Not-Sexually Abused Women 

Among the 148 women completing the study, 100 women (68%) reported forced sex as 

least once during the relationship. The demographics of the women sexually assaulted and notsexually assaulted are presented in Exhibit 1. There were no statistical differences between 

groups on any of the demographic characteristics. The majority of women were US born and 

English speaking. Over 75% of the women in each group reported employment, most had at least 

a high school education, and most reported an income of less than $20,000. At entry into the 

study in January 2001, two-thirds of the women, both sexually assaulted and not sexually 

assaulted, categorized their relationship to the abuser as current spouse or common law spouse. 

Twenty-four months later, January 2003, only one third of the women categorized the 

relationship as current spouse or common law spouse. 

To further examine the change in the relationship status between contacting the justice 

system (i.e., entry into our study) and 24 months later, Exhibit 2 was formed. Twenty-nine 

percent of the women, who categorized the relationship as current at entry into the study, 

reported the relationship as former two years later. Conversely, only 3% of the women reporting 

the relationship as former at intake reported the relationship as current at 24 months. During a 

two year period one third of the women, both sexually assaulted and not-sexually assaulted 

groups, changed their relationship with the abuser from current to former. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
12

Characteristics of Intimate Partner Sexual Assault 

Type and Frequency of Sexual Assault 

The type and frequency of sexual assault is presented in Exhibit 3. Some 62% of the 

women reported being forced into sexual intercourse four or more times, 37% reported forced 

oral sex and 27% reported forced anal sex. Many women reported multiple forms of sexual 

assault. When asked if she had experienced sexual assault more than once, 79% of the women 

responded yes. Fifty-five percent of the women reported that the second sexual assault occurred 

within one month of the first assault. 

To determine if the frequency of sexual assault varied by ethnic group or country of birth, 

a one-way analysis of variance was completed on the mean sexual assault scores. The results 

appear in Exhibit 3a and 3b. Sexual assault scores ranged from 1 to 15. Although white women 

had the highest mean score of 7.22, compared to African American women at 5.37 and Hispanic 

women at 5.92, there was no statistical difference between ethnic groups. Likewise, no statistical 

difference occurred between mean sexual abuse scores for US born compared to non-US born 

women. 

Temporal Sequencing of Sexual Assault 

The mean number of years from meeting the abuser to the first sexual assault, first 

physical assault, and application for a protection order in January 2001 by ethnicity and country 

of birth appears in Exhibit 4. Also, the mean number of years from the first consensual sex to the 

first sexual assault, and first sexual assault to additional sexual assaults, by ethnicity and country 

of birth, appear in Exhibit 4. There were no significant differences between mean number of 

years to any of the events and ethnic group; however, there were two significant differences by 

country of birth. Compared to US born women, non-US born women reported significantly 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
13

(p=.03) more years from meeting the abuser to the first sexual assault and significantly (p=.01) 

more years from the first consensual sex to the first sexual assault. 

The actual number of years from meeting the abuser to the first sexual assault, and first 

consensual sex to the first sexual assault, are presented in Exhibit 5. Thirty-eight percent of the 

women were sexually assaulted within two years of meeting the abuser, and 52% were assaulted 

within two years of the first consensual sex. However, for over one third of the women (35%), it 

was longer than 5 years from meeting the abuser until the first sexual assault and, for 28% of the 

women, it was longer than 5 years from the first consensual sex experience to the first sexual 

assault. 

When asked about the temporal sequencing of physical and sexual assault, 30% of the 

women reported that sexual assault preceded the physical assault. As one woman explained, 

“When I began to resist the forced sex by kicking and pushing him away, he began to hit, punch, 

and hold me down”. Most women waited several years after the first sexual assault before 

applying for a protection order with White women waiting the longest, 8 years on average, 

followed by Hispanic women, 5 years on average. African American women waited on average 3 

years (see Exhibit 4). 

Relationship Circumstances and the First Sexual Assault

The women were asked a series of questions about the status of their relationship with the 

abuser and abuser behaviors at the time of the first and subsequent sexual assaults. When asked 

if the relationship had changed prior to the first sexual assault, most women (83%) felt the 

relationship was different. Reported changes in the relationship are listed in Exhibit 6. Thirtythree percent of the women reported the abuser had become more violent, possessive or 

controlling. Twenty-two percent of the women reported an “emotional” separation prior to the 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
14

first sexual assault. Examples of “emotional separation” included statements of “we did not talk 

to each other anymore”, “I didn’t want to be with him anymore and he knew it”. Seventeen 

percent of the women reported an actual or pending physical separation from the abuser prior to 

the first sexual assault, and 15% of the women reported the abuser had begun to use illicit drugs 

or alcohol prior to the first sexual assault. 

Perpetrator Behaviors Immediately Before and After the First & Additional Sexual 

Assaults 

Abuser behaviors during the first and subsequent sexual assaults appear in Exhibit 7. 

Over 50% of the abusers used alcohol during the first and subsequent sexual assaults and 40% 

used illicit drugs, with 60% of the illicit drug use reported as crack or cocaine. Forty percent of 

the women reported physical abuse immediately before they were sexually assaulted for the first 

time. Almost 50% of the women reported physical abuse before additional sexual assaults. Thirty 

percent of the women reported physical abuse after the first sexual assault, and 35% reported 

physical abuse following additional assaults. Fifteen percent of the women reported threats of 

abuse immediately before or after the first and subsequent sexual assaults. 

Helpseeking Behaviors Immediately After the First & Subsequent Sexual Assaults 

The women were asked about their helpseeking actions following the first and subsequent 

sexual assaults. Women were asked if they told someone about the sexual assault, contacted the 

police, applied for a protection order, or received medical care or counseling. If the woman 

responded “yes” to contacting the police or applying for a protection order, she was asked if she 

received the order of protection and was the abuser arrested. Helpseeking behaviors were 

stratified by women who were and were not re-sexually assaulted after they sought help. This 

information appears in Exhibit 8 along with the test statistic. Twenty-six women (26%) told 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
15

some one about the first sexual assault, 6% contacted the police, 8% applied for a protection 

order, 9% received medical care and 3% received counseling. The behaviors of telling someone, 

contacting the police and applying for a protection order were significantly (p<.05) associated 

with a decreased risk of re-assault, with the largest reduction in risk associated with application 

for a protection order. 

The relative risk, 95% confidence interval and interpretation of a specific helpseeking 

behavior compared to not doing the behavior after the first sexual assault and risk of re- assault 

are presented in Exhibit 9. Women who contacted the police, irrespective of whether or not the 

abuser was arrested, were 59% less likely to be re-assaulted. Women who applied for a 

protection order, irrespective of whether or not the order was received, were 70% less likely to 

be re-assaulted. Stated another way, women who did not contact the police after the first sexual 

assault were 2.4 times more likely to be re-assaulted, and women who did not apply for a 

protection order after the first assault were 3.3 times more likely to be re-assaulted. 

Frequencies for helpseeking behaviors after re-assaults for women that did and did not 

perform helpseeking behaviors after the first sexual assault are presented in Exhibit 10. Telling 

someone, contacting the police, and receiving medical care after the first sexual assault was 

significantly (p<.05) related to repeating these same behaviors after re-assaults. The likelihood of 

helpseeking after re-assaults if the woman did or did not seek help after the first sexual assault is 

presented in Exhibit 11. Women who told someone after the first sexual assault were 2.5 times 

more likely to tell someone after re-assaults. Women who contacted the police after the first 

sexual assault were 7.7 times more likely to contact the police after re-assaults. Women who 

received medical care after the first sexual assault were 8.3 times more likely to receive medical 

care after re-assaults. None of the women who applied for a protection order after the first sexual 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
16

assault applied after re-assaults. Likewise, none of the women who received counseling after the 

first sexual assault went for counseling after re-assaults. Helpseeking behaviors were repeated 

and all helpseeking reduced the risk of re-assault. 

CONSEQUENCES OF INTIMATE PARTNER SEXUAL ASSAULT FOR WOMEN 

Violence and Health Measures at Time of Application for a Protection Order 

Type and extent of intimate partner violence, as measured by the Severity of Violence 

against Women, Danger of Femicide, Stalking and Work Harassment Scales, as well as mental 

and physical health functioning for sexually assaulted and not-sexually assaulted women was 

assessed when the women applied for a protection order in January 2001. Mean scores and 

results from analysis of variance, by ethnic group, appear in Exhibit 12. Exhibit 13 presents the 

same scores by country of birth. 

Sexually assaulted women reported significantly (p=.002) more danger of femicide as 

well as more episodes of work harassment (p=.009) compared to not-sexually assaulted women. 

When mean differences for physical and mental health functioning were examined, sexually 

assaulted women reported significantly (p=.03) worse mental and physical health functioning. 

There were no significant differences between ethnic groups on any of the violence or 

health measures, neither were there any interactions between sexual assault and ethnicity 

(Exhibit 12). This means that regardless of a woman’s ethnic group, sexually assaulted women 

report significantly (p<.01) more risk factors for femicide, more episodes of work harassment 

and poorer physical and mental health compared to not-sexually assaulted women. Exhibit 14 

lists the frequency for each risk factor for femicide for sexually abused compared to not-sexually 

abused women. Sexually assaulted women reported significantly more threats of murder from

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
17

the abuser, more threats by the abuser to harm the children, more illicit drug use by the abuser, 

and more threats and/or attempts by the woman to commit suicide. 

There were no significant differences between US born and non-US born women on any 

of the violence or health measures and there were no interactions (Exhibit 13). The lack of a 

statistical interaction means, regardless of whether a woman was born in the US or not US born, 

if the women reported sexual assault, they reported significantly more risk factors for femicide, 

and worse physical and mental health functioning. 

Psychological Measures Two Years after Application for a Protection Order 

Mental health, as measured on the Brief Symptom Inventory (BSI), social support, as 

measured on the Medical Outcomes Study, Post-traumatic Stress, and Family Hardiness for 

sexually assaulted and not-sexually assaulted women was assessed 24-months after the women 

applied for a protection order. Mean scores were calculated for sexually assaulted and notassaulted women by ethnic group (Exhibit 15) and country of birth (Exhibit 16). 

Post-traumatic stress was the only health measure that showed a significant difference 

between sexually assaulted and not-sexually assaulted women (Exhibit 15). Sexually assaulted 

women reported significantly (p=.02) more post-traumatic stress symptoms compared to notsexually assaulted women. There was one significant (p=.003) difference between ethnic groups. 

Regardless of sexually assaulted or not-assaulted, Hispanic women reported significantly higher 

mean post-traumatic stress scores compared to African American (p=.005) and White women 

(p=.012) (Exhibit 15). 

There were two significant differences on psychological scores according to country of 

birth (Exhibit 16). Regardless of sexually assaulted or not sexually assaulted, non-US born 

women reported significantly (p<.001) higher mean post-traumatic stress scores compared to US 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
18

born women. Additionally, these same non-US born women reported significantly (p=.007) 

fewer sources of social support (Exhibit 15). Exhibit 17 lists the frequency for symptoms of posttraumatic stress for sexually assaulted compared to not-sexually assaulted women. Sexually 

assaulted women reported appreciable more problems with sleeping and trying to avoid thinking 

about the abuse. To determine if a relationship existed between post- traumatic stress and sexual 

assault scores, a correlation was computed. The correlation of .16 (p=.104) showed a trend 

towards a significant positive relationship, indicating the greater the frequency of sexual assault 

the more symptoms of post-traumatic stress disorder. 

Health Problems Attributed to Sexual Assault 

The women were asked if they experienced a sexually transmitted disease, certain health 

problems, rectum or vaginal bleeding, or began or increased nicotine, alcohol, or illicit drug use 

following the sexual assaults. The women’s responses, according to whether they reported one or

more than one sexual assault, are listed in Exhibit 18 along with the relative risk and 95% 

confidence intervals. Women reporting more than one sexual assault reported significantly more 

health problems compared to women reporting one assault. Bacterial vaginosis, Chlamydia, 

genital herpes, genital warts, crabs, gonorrhea and pelvic inflammatory disease were only 

experienced by women reporting more than one sexual assault. One third of the women reported 

beginning or increasing use of alcohol, nicotine, or illicit drugs because of the sexual assaults, 

with 27% of the women reporting alcohol use. When illicit drug use was reported by the women, 

cocaine was the drug most often reported. One-fifth of the women reported problems with 

intimacy and sexual functioning. As one woman explained, “When I tried to have sex with 

another man, I froze with fear” and “It was a long time before I could enjoy sex again”. Onethird of the women reported anxiety and depression following the sexual assaults. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
19

Sexual Assault & Suicidality 

In January 2001, when the women entered our study, each woman was asked if she had 

threatened or attempted suicide within the past 90 days. Whereas 4% of the not-sexually 

assaulted women answered “yes”, 24% of the sexually assaulted women answered “yes”. Two 

years later, in January 2003, the women were asked if, during the preceding seven days, they had 

experienced thoughts of ending their life. Although 4% of the not-sexually assaulted women 

answered “yes”, 9% of the sexually assaulted women reported “yes”. 

Rape-Related Pregnancy 

Twenty women reported a total of 32 pregnancies resulting from sexual assault. 

Outcomes for these 32 pregnancies were 26 (81%) live birth, 5 (16%) elective abortion and 1 

(3%) still birth. There were no miscarriages. When asked if the abuser ever forced sex during 

pregnancy, 24 women (31% of the women that had experienced a pregnancy) reported a total of 

52 pregnancies accompanied with one or more episodes of sexual assault. Outcomes of these 52 

pregnancies were 46 (88%) live births, 3 (6%) elective abortions, and 3 (6%) spontaneous 

abortions. 

Sexual Decision Making and Sexual Assault

Type and frequency of mutual decision making about sexual relations, condom use, and 

birth control is presented in Exhibit 19 with the test statistic. Significantly (p<.01) less mutual 

decision making about having sex and using condoms was reported by sexually assaulted 

compared to not-assaulted women. Type and frequency of actions surrounding birth control, 

condoms, and pregnancy are presented in Exhibit 20 along with the test statistic. Only sexual 

assault abusers refused to use birth control. These same men were far more likely to never use 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
20

condoms. Over one fourth (26%) of the sexually assaulted women became pregnant because the 

abuser would not use birth control compared to only 5% of the never sexually assaulted women. 

CONSEQUENCES OF INTIMATE PARTNER SEXUAL ASSAULT FOR CHILDREN 

Child Witness to Intimate Partner Assault and Counseling Received 

Seventy-seven percent of the 148 women had one or more children. When asked if any of 

their children had ever seen or heard the physical or sexual abuse, 88% of the women answered 

yes. A total of 205 children were reported to have been exposed to the abuse of their mother. The 

age of these children when first exposed to abuse is presented in Exhibit 21 and graphed in 

Exhibit 22. More than one-third of the children (36%) were exposed to violence for the first time 

during infancy and 64% were exposed by age three. 

When asked if the child exposed to violence ever received counseling, only 65 children 

(33%) received counseling. When asked how helpful the counseling was, 82% of the mothers 

rated the counseling as “very helpful”, or “somewhat helpful”. 

Behaviors of Children Exposed and Not-Exposed to Intimate Partner Sexual Assault 

Mean scores, standard errors, group differences, and standardized effect sizes are shown 

in Exhibit 23. Results of the MANOVA and ANOVA showed no significant differences between 

the abuse groups for children between 1.5-5 years of age. When gender was added to the model, 

the results remained unchanged. For the older children, results from the MANOVA, adjusting 

for age group, showed a significant multivariate effect (F(2,87)=3.99, p=0.022) for the age group 

by abuse group interaction. Follow-up ANOVAs yielded an interaction effect that was just past 

significance (F(1,88)=4.45, p=0.038 with critical p <.025) for internal behaviors. Further 

examination of the internal scores showed that mean scores for the 6-11 yr olds were practically 

equal with values of 53.2 (SE=1.94) and 53.1 (SE=2.26) for youngsters of the sexually assaulted 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
21

and not-assaulted mothers, respectively. However, internal mean scores for children between 

12-18 years of age showed that scores for youngsters of the sexually assaulted group (M=61.9, 

SE=2.41) were higher than mean scores for youngsters from women who were not sexually 

assaulted (M=51.0, SE=3.41). Furthermore, the mean score for the 12-18 year olds from mothers 

who were sexually assaulted were above the cut-off for the clinically referred range (values > 

60). These findings indicate older youth, age 12-18 years, of sexually assaulted mothers are more 

likely to be depressed, compared to youth of physically abused only mothers, and not any less 

depressed than youth of the same age receiving treatment. Exhibit 24 compares the scores of 

youngsters of sexually assaulted mothers and physically assaulted only mothers to referred and 

non-referred norm scores. 

Women Who Were Physically but Not Sexually Assaulted

Women physically, but never sexually, abused were asked if they had ever worried about 

sexual assault. Among the 48 women never sexually assaulted, 8 women (17%) reported being 

worried about forced sex. Seven of these women reported changes in the intimate relationship, 

such as a separation, pregnancy, or an increase in physical abuse. Only three women discussed 

their worry of a possible sexual assault with someone. When these three women shared their 

worry of sexual assault it was with family or friends. Among the women that reported they never 

worried about forced sex, 85% stated that the abuser always took “no” to sex as an absolute 

answer. The remaining 15% of the women all stated the abuser went elsewhere for sex if they 

said no. 

Social & Family Functioning of Sexually and Not-Sexually Assaulted Women 

Although sexually assaulted women, regardless of ethnic group or immigrant status, had 

lower scores on both family hardiness and sources of social support (see Exhibits 15 and 16) 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
22

only social support for non-US born women was statistically lower (p=.007) compared to US 

born women. 

RESULTS SUMMARY 

Sexual assault of women by their intimate partners is common, severe, repeated and does 

not vary by ethnicity or country of birth. The first episode of sexual assault usually occurs within 

two years of the first consensual sex and is associated with a change in the relationship, most 

frequently increased violence, or a pending or actual separation of the couple. At the time of the 

sexual assaults, 50% of the women reported the abuser was using alcohol, and 40% of the 

women reported the abuser was using illicit drugs, usually crack or cocaine. Over 40% of the 

women reported physical abuse immediately before the sexual assault, and 30% of the women 

reported physical assault immediately afterwards. Fifteen percent of the women reported being 

threatened before and/or after the sexual assaults.

One third of the women told someone about the first sexual assault. Helpseeking with the 

justice system, either by contacting the police or applying for a protection order, or receiving 

medical care after the first sexual assault, is associated with a major reduction in the risk of 

further assaults. Helpseeking is repeated. Women who tell someone about the first sexual assault, 

or contact justice or health services, are very likely to re-contact these agencies after additional 

assaults. 

Consequences for women associated with intimate partner sexual assault include 

increased danger for murder by the abuser, more symptoms of post-traumatic stress disorder, 

worse physical and mental health, and a higher likelihood of threatening and/or attempting 

suicide. Sexually assaulted women attribute major health problems to the sexual assaults, 

including sexually transmitted diseases, pelvic inflammatory disease, substance use, anxiety, 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
23

depression and unintended pregnancy. Twenty percent of the women reported at least one raperelated pregnancy with 16% of these pregnancies ended with an elective abortion. Thirty percent 

of the women were sexually assaulted during pregnancy. 

Eighty-eight percent of the children witness the physical and/or sexual assault toward 

their mothers, many during infancy, and most, 64 percent of the children, witnessed the violence 

by age three. Only 33 percent of the children received counseling. However, when children do 

receive counseling, and mothers are asked to rate the counseling, 82% of mothers state the 

counseling was “very helpful”, or “somewhat helpful”. Sexual assault of mothers affects the 

behaviors of their children with children; age 12 to 18 being the most affected and displaying 

symptoms of depression not different from children being treated for depression. 

DISCUSSION OF RESEARCH FINDINGS 

Characteristics of the Sexual Assault Event 

A few descriptive studies exist that chronicle the characteristics and consequences of 

intimate partner sexual assault. Campbell and Alford (1989) surveyed 1,000 women currently 

living in battered women’s shelters across the United States. Among the 115 women who 

returned the survey (12% of the 1000 women surveyed), 44% reported physical assault during 

sex, and 51% reported rape following physical assault. Weingourt (1990) found 58% of a sample 

of 33 raped wives reported physical assault during the rape. These figures are comparable to our 

finding that 40% of the women reporting physical assault during the first sexual assault and 50% 

during re-assaults. Bennice and Resick (2003) suggest two explanations for the concurrent 

occurrence of physical and sexual assault. One possibility they posit is that sexual assault is used 

by the abuser as another form of assault during a physically abusive episode, similar to reaching 

for a weapon. A second possibility is that sexual assault intimates do not view forced sex as 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
24

assault, and instead, they are attempting to have sex as a form of apologizing for the physical 

assault. An apology possibility is consistent with Walker’s (1979, 1981, 2000) three phase Cycle 

of Violence with the honeymoon and making-up behaviors as the phase following the assault. 

Our findings support the first explanation of extended violence, especially since 30% of the 

women in our sample reported physical assault following sexual assault. 

Helpseeking Following Sexual Assault 

It is well documented that only 16%-25% of sexual assaults are reported to the police, 

with the reporting rate lowest when the woman knows the assailant (Rennison, 2002; Resnick et 

al., 2000). In our study only 6% of the sexually assaulted women contacted the police after the 

first assault and 15% after the second assault. This is especially concerning as 50% of the 

sexually assaulted women in our study reported physical assault also during the sexual assault. 

Similarly, most victims of sexual assault do not receive medical attention following the event 

(Rennison, 2002). National estimates are that only 26% of women receive medical care 

following sexual assault with women who report sexual assault to the police nine times more 

likely to seek medical care (Resnick et al., 2000). Another study reports 50% of injured female 

victims of sexual assault reporting the crime to the police also received medical treatment, 

compared to a fifth of those women not reporting to police (Rennison, 2002). In our study, 50% 

of women reporting to the police after the first sexual assault also received medical care. Only 

33% of the women in our study contacting the police after the second sexual assault also 

received medical care. Reporting to police initiates the protocol to collect forensic evidence, 

which is performed by a medical provider. Alternatively, sexual assault victims who go directly 

to a medical care facility for treatment may be asked to report to police in order to receive 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
25

emergency forensic medical care that may be funded by the state (Young, Bracken, Goddard & 

Matheson, 1992). 

 In our study 9% of the women received medical care immediately following the first 

sexual assault and 14% following the second sexual assault. Although contact with the police 

and medical care increased from the first to second assault, only 50% of women contacting the 

police also received medical attention. Anonymity is a frequently cited reason for women not 

contacting the police and medical care (Resnick et al., 2000). A cooperative medical and justice 

system model that encourages, and perhaps even subsidizes, medical care for all sexual assault 

victims and also permits anonymity as an option for sexual assault victims receiving forensic 

examinations is recommended as a strategy for facilitating sexual assault victims’ access to 

justice and health services. 

Finally, 8% of the women applied for a civil protection order following the first sexual 

assault and 19% following subsequent assaults. It is well known that abused women often seek 

civil protection orders to end the violence (McFarlane, 2004). A collaborative model of justice 

and health care that encourages women seeking orders of protection following sexual assault to 

also seek medical care is highly recommended. 

Risk of Re-Assault Following Helpseeking with Justice Agencies 

Sexually assaulted women who contacted the police or applied for a protection order after 

the first sexual abuse were at much lower risk for re-assault. Contacting the police, irrespective 

of whether or not the abuser was arrested, and applying for a protection order, irrespective of 

whether or not the order was received, was associated with up to a 70% risk reduction for reassault. However, women that did not contact the police after the first sexual assault were twice 

as likely to be re-assaulted, and women that did not apply for a protection order were three times 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
26

more likely to be re-assaulted. These results agree with those of other longitudinal studies 

reporting significantly lower levels of violence experienced by women seeking assistance from

the justice system, irrespective of the justice system outcome (McFarlane, et al., 2004b; Gist, 

etal., 2001; McFarlane, et al., 2000). 

The significant risk reduction for re-assault among women who contacted the justice 

system is consistent with abuse intervention findings reported by social and health researchers. In 

one study, abused women exiting a shelter and receiving home social support were compared, at 

6 months, with abused women not receiving such support; women in both groups reported 

decreases in physical abuse (Sullivan, 1994). In two health clinic studies involving comparisons 

of abused women receiving intensive counseling and outreach support and abused women 

offered a wallet-sized card listing community abuse resources, women in both groups reported 

significantly lower levels of violence 6, 12, and 18 months post intervention (McFarlane, et al., 

2000; Parker, et al., 1999). 

Do findings from this study and others indicate that the justice intervention of a 

protection order or arrest of the abuser, and the health and social service interventions of 

counseling, support, and referrals, are no more of a deterrent to future violence than an abused 

woman’s contact with assistance agencies? When an abused woman decides to contact criminal 

justice, civil justice, health, or social service agencies, information about the abuse is shared, and 

contact is made. Just as the privatization of domestic violence contributes to its continuation, 

perhaps the contact and public knowledge stemming from justice encounters can prevent 

reoccurrence of violence. Perhaps, just as legal sanctions (e.g., requirements involving the use of 

helmets and seat belts) have proven effective in reducing unintentional injuries, legal sanctions 

can reduce the occurrence of intentional intimate partner violence. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
27

A qualitative study focusing on reasons why women seek civil orders of protection 

revealed a desire among women to regain some measure of control in their lives by making the 

abuse public (Fischer & Ross, 1996). These women discussed using the application for a 

protection order as a “loudspeaker” to notify the abuser that the law knew about his behavior. 

They viewed the legal system as a force larger than themselves and as having power over the 

abuser that they themselves had lost as a result of the abuse. Moreover, they felt a need to have 

the legal system both approve and reinforce their decision to leave the abuser. The protection 

order became an announcement that the abused woman refused to “take it” anymore and was 

acting on her own behalf. Our results support these findings. When sexually assaulted women in 

this study made the assault public, by contacting the justice system, a significant reduction in the 

likelihood of re-assault was reported. 

Our findings demonstrate that, irrespective of whether or not an abuser is arrested, or a 

protection order received, sexually assaulted women who contact the justice system, following 

the first sexual assault, reported less re-assaults. Clearly, accessible, acceptable, and known 

locations of justice services, such as the one-stop Family Justice Centers which contain justice, 

health, legal, and social services within one agency, can potentially facilitate early contact of 

abused women with the justice system and interrupt existing assault and prevent further abuse. 

CONSEQUENCES OF SEXUAL ASSAULT ON WOMEN’S PHYSICAL HEALTH 

Gynecologic Problems

Gynecologic problems are the most consistent, longest lasting, and largest physical health 

difference between abused and non-abused women. Conditions of sexually-transmitted diseases, 

vaginal bleeding or infection, fibroids, genital irritation, pain on intercourse, urinary-tract 

infections and pelvic pain and inflammatory disease are far more likely to be reported by abused 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
28

women (Tollestrup, et al., 1999; Campbell & Soeken, 1999; Coker, et al., 2000; Campbell et al., 

2002; Johnson & Hellerstedt, 2002). In one US population-based study of self-reported data, the 

odds of having a gynecological problem were three times greater than average for victims of 

spouse abuse (McCauley, et al., 1995). Another study of 201 abused women found 30% of 

sexually abused women reported three or more gynecologic health problems compared to only 

8% of women who experienced physical abuse alone and 6% of women never abused (Campbell 

et al., 2002). The incidence of gynecologic health problems among physically but not sexually 

abused women was not appreciably different from the incidence of the non-abused women. 

Sexual assault and associated consequences may explain these gynecological differences. 

For example, vaginal, anal, and urethral trauma from forced sex (blunt force and lack of 

lubrication) can lead to increased transmission of microorganisms through direct transmission 

into the bloodstream or back flow of bacteria in the urethra. Additionally, the shame and stress 

associated with forced sex can act to depress the immune system and increase susceptibility to 

infection and disease. We found no other study that measured intimate partner sexual assault 

separately from physical assault and associated occurrence of specific sexually transmitted 

disease. 

Sexually Transmitted Diseases 

Sexually transmitted diseases (STD’s) are frequently reported by abused women. Among 

a sample of 115 abused women, 6.5 percent of the women reported contracting a STD as a direct 

result of forced sex and 17.6 percent reported an unwanted pregnancy following sexual assault 

(Campbell & Alford, 1989). Our data show higher rates of sexually transmitted diseases 

attributed to sexual assault, with Chlamydia reported by 9% of the women, gonorrhea 

experienced by 6% of the women, and herpes contracted by 5% of the women. Among the 100 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
29

women who reported sexual assault in our study, 15% attributed at least one episode of 

Chlamydia, crabs, genital herpes, genital warts, or gonorrhea to the sexual assault. 

Sexually transmitted diseases may follow forced sex with an infected partner and/or the 

limited ability of abused women to negotiate condom use with the abusive partner. In fact, 

Wingood and DiClemente (1997) report abused women were significantly less likely to report 

the use of condoms than not-abused women and were 9.2 times more likely to report being 

threatened with physical abuse after requesting their partners to use condoms. These women 

worried more about acquiring the human immunodeficiency virus (HIV) and felt more isolated 

than did women not in abusive relationships. Likewise, Davila and Brackley (1999) noted similar 

reports of physical and/or psychological abuse and accusations of infidelity following requests 

for condom use by Mexican and Mexican-American abused women. 

 In our sample, sexually assaulted women reported significantly less mutual decision 

making regarding having sex and the use of condoms, compared to not-sexually assaulted 

women, with 69% of the sexually abused women wanting to use condoms to prevent sexually 

transmitted diseases compared to 50% of the not-sexually abused women. Furthermore, the 

sexually assaulted women were five times more likely than the not-sexually abused women to 

report a pregnancy following the abuser’s refusal to use birth control. Clearly, sexually assaulted 

woman are in greater danger of both sexually transmitted diseases and unintended pregnancies. 

Rape-Related Pregnancy 

Unintended pregnancies account for about half of all pregnancies in the US (Henshaw, 

1998). Some of these unintended pregnancies follow sexual assault. To determine the national 

rape-related pregnancy rate, a national probability sample surveyed 4,008 women over a period 

of three years and found a national rape-related rate of 5%, with a disproportionate number of 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
30

pregnancy rapes among adolescents (Holmes, et al., 1996). This national estimate of 5% is 

appreciably lower than the 20% rape-responsible pregnancy rate found in this study. 

Additionally, none of the women in our study were adolescents. Our research suggests women 

sexually assaulted by an intimate partner are at a four fold increase of experiencing a rape-related 

pregnancy. The sexual assault continued into pregnancy with 31% of our sexually assaulted 

women reporting sexual assault during pregnancy. 

Ill Health During Pregnancy, Poor Infant Outcomes & Femicide 

 Extensive research suggests a clear relationship between intimate partner assault during 

pregnancy and adverse health outcomes for both mother and child. Lower infant birthweight, 

substance use during pregnancy, as well as preterm labor and inadequate prenatal care, are 

significantly related to abuse during pregnancy (McFarlane, et al., 1996; Curry, 1998; Renker, 

1999). Additionally, women physically abused during pregnancy are at a three fold increase of 

femicide (McFarlane, et al., 2002c). Since one-third of the women in our study were sexually 

assaulted during pregnancy, and reported more risk factors of femicide compared to the 

physically abused only women, women sexually assaulted during pregnancy may be at an 

exceptionally high risk of femicide. Pregnant women reporting sexual assault must be advised by 

justice and health professionals of their increased risk of femicide. 

Elective Abortion 

There is evidence to suggest that sexually assaulted women may be more likely to 

terminate pregnancies as a strategy to eliminate this source of power and control within the 

relationship (Evins & Chescheir, 1996). In our study, 16% of pregnancies resulting from sexual 

assault were ended with an elective abortion. However, we did not ask the percentage of 

consensual sex pregnancies terminated with an elective abortion. Latest statistics from the Texas 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
31

Department of Health (1998) document 19% of reported pregnancies ended with an elective 

abortion. How many of these pregnancies resulted from sexual assault are unknown. Clearly, 

further research is needed to document the connection between sexual assault, unintended 

pregnancy and elective abortion. 

CONSEQUENCES OF SEXUAL ASSAULT AND WOMEN’S MENTAL HEALTH 

One meta-analysis was identified that reviewed over 50 articles to determine a mean 

prevalence of alcohol and drug use, depression, post-traumatic stress disorder and suicidality for 

women reporting intimate partner violence (Golding, 1999). Although the studies reviewed in the 

meta-analysis did not separate intimate partner physical assault from sexual assault, and varied 

appreciably in populations sampled, measures used, and definitions of terms, we feel the 

weighted mean prevalence figures are representive of existing literature and will be used to 

compare the findings of our study. 

Temporal sequencing of mental health problems in abused women is essential for 

effective treatment strategies as well as secondary prevention efforts. Mental health problems 

may be related to other life stressors that usually accompany violence, such as changes in 

residence, unemployment, marital separation, and child behavior problems. Some abused women 

suffer from chronic mental health problems, such as depression or substance use, exacerbated by 

a violent relationship or a mental health problem, such as post-traumatic stress disorder or 

suicidality, which may be triggered by the initiation of abuse. In addition to comparing our 

findings to published prevalence rates, we also looked for studies of temporality of mental health 

problems and intimate partner violence. 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
32

Alcohol, Illicit Drug and Nicotine Use 

Golding (1999) reports rates of alcohol abuse among battered women ranged from 6.6% 

to 44% with a weighted mean of 18.5% across 10 studies. This compares to lifetime prevalence 

reports of 4.6% (Helzer et al., 1991) and 8.2% (Kessler et al., 1994) in general populations. The 

weighted mean odds ratio linking intimate partner violence and alcohol abuse was 5.56 (95% CI 

3.32, 9.31) (Golding, 1999). In our study, 10% of women experiencing one sexual assault, and 

27% of women experiencing more than one sexual assault, attributed beginning or increasing use 

of alcohol use because of the sexual assault. We identified one two-year longitudinal study by 

Kilpatrick and associates (1997) that found new assaults associated with alcohol abuse. 

Golding (1999) reports that rates of illicit drug use among abused women ranged from

7% to 25% across four studies, with a weighted mean of 8.9%. This compares to lifetime 

prevalence of 4.8% (Anthony and Helzer, 1991) to 5.9% (Kessler et al., 1994) in general 

populations of women. The weighted mean odds ratio linking intimate partner violence and illicit 

drug use was 5.62 (95% CI 3.55, 7.72) (Golding, 1999). In our study, none of the women who 

reported one sexual assault and 9% of the women who reported more than one sexual assault 

attributed beginning or increasing use of illicit drugs because of the sexual assault. Regarding 

temporal sequencing, Kilpatrick and associates (1997) also found new assaults associated with 

drug use. 

We identified only one study that compared smoking of abused to non-abused women. 

In a study of 1,203 pregnant women, McFarlane and associates (1996) found 50% of AfricanAmerican women reporting abuse also smoked, compared to 34% of the non-abused women. For 

white women, 60% of the abused women smoked, compared to 47% of the non-abused. No 

temporality was established in the McFarlane (1996) study. In our study, 10% of the women who 

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been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
33

experienced one sexual assault and 22% of women who experienced more than one sexual 

assault attributed beginning or increasing use of nicotine because of the sexual assault.

We identified no other studies with victims who attributed alcohol, illicit drug or nicotine 

use as a consequence of sexual assault. Our study is limited in that we did not ask physicallyassaulted-only women about their use of substances following the physical assault. Additionally, 

we asked about “use of substances” not “abuse of substances”. However, information about 

temporal sequencing of substance use following sexual assault is lacking from the literature. Our 

study offers the first look at the large percentage of victims that attribute substance use, both 

initial and increased use, to sexual assault. If sexual assault contributes to alcohol, illicit drug, 

and nicotine use, interventions aimed at these problems will not succeed without preventing and 

addressing sexual assault. 

Depression

Golding (1999) reports the weighted mean prevalence of depression among battered 

women as 47.6%, across 18 studies. This compares to a lifetime prevalence rates of 10.2% 

(Weissman et al., 1991) to 21.3% (Kessler et al., 1994) on a lifetime basis. The weighted mean 

odds ratio linking intimate partner violence and depression was 3.80 (95% CI 3.16, 4.57) 

(Golding, 1999). In our study, 10% of the women who reported one sexual assault and 27% of 

the women who reported more than one sexual assault attributed anxiety and depression to the 

sexual assault. 

When Coker and associates (2002) compared depression scores of physically and 

sexually assaulted women to those of physically assaulted only women, the sexually assaulted 

women were at higher risk to both past problems of depression, as well as current depression. 

Among women in our study, we found no difference in depression scores between sexually 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
34

assaulted and not-assaulted women. However, we measured depression two years after the 

women contacted the justice system, and for most women, this was two years after the violence 

had ended (McFarlane et al, 2004b). 

A few studies have sought to establish the temporal proximity of depression to assault. 

Campbell et al. (1995) found that 83% of women who had just left a battered women’s shelter 

were depressed; over six months, rates declined slightly for women who had been recently 

battered at the time of follow-up (to 71%) and appreciably ( to 49%) for women who had not 

been recently abused. Another study by Campbell and Soeken (1999b) found depression 

declined over time once the violence ended. Likewise, Surtees (1995) found the rates of major 

depression declined from 28.1% for the 6-month period before entering a shelter to 9.2% during 

the 6-month period following shelter entry. None of these studies separated physical assault only 

from physical and sexual assault. Certainly the need to chronicle the occurrence and resolution of 

depression among physically and sexually assaulted women is great. 

Post-Traumatic Stress Disorder 

Golding (1999) reports rates of post-traumatic stress disorder among abused women 

ranged from 7% to 25% across 11 studies, with a weighted mean of 63.8%.This compares to 

estimates of lifetime prevalence in general populations of women of 1.3% to 12.3% (Kessler et., 

1995), including 9.4% of those without a history of crime victimization and 25.8% of those with 

such a history (Resnick et al., 1993). The weighted mean odds ratio linking intimate partner 

violence and post-traumatic stress disorder was 3.74 (95% CI 2.05, 6.83) (Golding, 1999). No 

studies of temporality were located. Our study found a prevalence of post-traumatic stress 

disorder of 52% for both sexually assaulted women and physically assaulted only women. 

Although the percentage of affected women was the same, the sexually assaulted women 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
35

reported more symptoms of post-traumatic stress disorder, especially sleep disturbances, and 

significantly higher scores compared to physically assaulted only women. 

A recent study compared intimate partner sexual assault victims to women who have 

experienced physical assault alone and found that women who have experienced physical and 

sexual abuse tend to have higher levels of post-traumatic stress disorder and depression 

(Bennice, et al., 2003). However, severity of physical assault did not predict severity of posttraumatic stress. Rather, intimate partner sexual assault continued to significantly predict posttraumatic stress even after controlling for the severity of physical violence. Our results concur. 

We found that sexually assaulted women reported significantly higher post-traumatic stress 

scores compared to physically assaulted women only. Additionally, we found a trend (p=.10) 

towards a positive relationship between post-traumatic stress scores and sexual assault scores, 

indicating the greater the frequency and severity of sexual assault the more symptoms of posttraumatic stress. 

Is the sexual assault predicting the post-traumatic stress or is the threat of physical and/or 

sexual assault used by the perpetrator to gain sexual access to the victim more often, thus 

increasing the frequency of sexual assault overall in the relationship? Our results did not show a 

significant increase in physical abuse, or threats of abuse, for sexually assaulted women, 

compared to non-sexually abused women. This finding is in contrast to other reports of intimate 

partner sexual assault associated with more severe physical assault (Bennice et al., 2003; 

Kilpatrick et al., 1988; Meyer et al., 1998). Seemingly, the act of sexual assault itself accounts 

for an increase in post-traumatic stress symptoms. Consistent with this explanation, a survey of 

women who reported rape to be their most upsetting trauma found 45.9 percent of the women 

developed post-traumatic stress disorder. In contrast, for women who considered physical attacks 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
36

to be most upsetting trauma, only 21.3% of the women developed post- traumatic stress disorder 

(Kessler, et al., 1995). These findings lend support to the notion that there indeed may be 

something unique to the experience of sexual assault that increases the likelihood of developing 

post-traumatic stress disorder. 

The findings of our study have notable clinical implications in that our women were 

experiencing symptoms of post-traumatic stress disorder two years after applying for a protection 

order and, for most women, two years after the violence had ceased (McFarlane et al., 2002b & 

2004b). Many researchers consider post-traumatic stress disorder the most appropriate diagnostic 

category for experiences associated with intimate partner violence, even though symptoms of 

other disorders, such as depression, may be present (Browne, 1993; Koss et al., 1994). Because 

post-traumatic stress disorder and depression overlap (Friedman and Schurr, 1995) depression 

detected in some studies may represent symptoms of post-traumatic stress. Because the essential 

feature of post-traumatic stress disorder is the development of certain symptoms (i.e., sleep 

disturbances, hypervigilance) following exposure to an extreme traumatic stressor (American 

Psychiatric Association, 1994, p. 424), experiences following the stress of intimate partner 

violence can be interpreted as representing post-traumatic stress disorder. Conceptualizing 

battered women’s symptoms as reflecting post-traumatic stress disorder depathologizes the 

woman. Because post-traumatic stress disorder connects trauma and certain symptoms, it can 

facilitate understanding and meaningful treatments for abused women. 

It is important to document that in our study, post-traumatic stress scores were 

significantly higher for Hispanic women and non-US born women, irrespective of sexual abuse 

status. In our study, 93% of the non-US born women were first generation immigrants from

Mexico, 55% of these women did not speak English and 54% had not graduated from high 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
37

school (McFarlane et al, 2002b). Non-US born women in our study appear to be in double 

jeopardy; they experience levels of abuse no different from US-born women, but without the 

resources of social support, English proficiency and education with which to deal with the abuse. 

Our study findings indicate that non-US born abused women are at high risk to post-traumatic 

stress disorder and report significantly lower levels of social support compared to US born 

women. Abuse prevention programs for non-US born populations, that use language appropriate 

materials and resources, are urgently needed. 

The duration of symptoms of post-traumatic stress disorder is lengthy, can last for years 

and interfere with all activities of daily living. It is essential that justice and health agencies 

routinely assess for sexual assault and inform women who report assault of their increased risk of 

post-traumatic stress disorder. Information about what constitutes post- traumatic stress disorder, 

as well as community referral agencies, must be part of standard health and justice care for 

abused women. 

Suicidality 

Golding (1999) reports rates of suicidality among abused women ranged from 4.6% to 

77% across 13 studies, with a weighted mean of 17.9%.This compares to rates of 0.8% to 15.9% 

(ideation) and 0.1% to 4.3% (attempts) in general populations of women (Moscicki, 1989). The 

weighted mean odds ratio linking intimate partner violence and suicidality was 3.55 (95% CI 

2.73, 4.60). (Golding, 1999). 

Within 90 days of entering this study, 22% of the sexually assaulted women reported 

threatening or trying to commit suicide, compared to 4.2% of the not-sexually abused women. 

Sexual assault preceded each of these suicide threats or attempts. Previous research has also 

found suicide attempts to be more frequent among sexually assaulted women compared to notThis document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
38

sexually assaulted women (Kaslow, et al., 1998; Wiederman, Sansone, & Sansone, 1998; Coker 

et al., 2002); however, the temporal sequencing of the suicidality relative to the sexual abuse was 

not reported. To establish temporal order of sexual assault and suicidal behavior, a National 

sample of women, age 15 to 54, found both suicidal ideation and suicide attempts three times as 

likely to follow sexual assault as to occur prior to or within the same year of sexual assault 

(Ullman & Brecklin, 2002). Intimate partner sexual assault is a clear risk factor for suicide 

attempts and therefore should be a target of intervention and treatment for suicide prevention 

programs. 

In our study, both post-traumatic stress disorder and suicidality were more common 

among women reporting sexually assault. Although we know suicide threats and attempts 

followed sexual assault, we do not know the temporal sequencing of post-traumatic stress 

disorder relative to the sexual assault. Other research has documented that although posttraumatic stress disorder and depression are both significant predictors of suicide ideation; only 

depression was a significant predictor of suicide attempts (Ullman & Brecklin, 2002). This 

suggests that depression may be the critical factor in differentiating sexual assault victims who 

actually attempt suicide. In our study, suicide threats were not differentiated from suicide 

attempts. However, our results add to a growing literature demonstrating that sexual assault 

history is an important risk factor for suicidal behavior in women. Few victims of sexual assault 

seek mental health treatment. Delayed disclosure is common and may be associated with more 

serious assaults (Ullman, 1999). Additionally, healthcare professionals may not recognize or 

identify the sexual abuse or post-traumatic stress sequelae. There exists an urgent need for 

training of both justice and health personnel in the assessment of sexual assault, post-traumatic 

stress disorder, and suicidality. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
39

Femicide 

Sexual assault is associated with an increased risk of femicide (Campbell, et al, 2003; 

McFarlane, et al., 2002c). This study found significantly more risk factors of femicide reported 

by sexually assaulted women when compared to physically assaulted only women. Highly 

significant in this study was the finding of a significant increase in threats to harm the children 

by men who sexually assaulted women as well as threats to murder the woman. This finding is 

essential knowledge for justice personnel, especially as decisions are made for orders of 

protection and the inclusion of children on the order. 

CONSEQUENCES OF MOTHERS ASSULT ON CHILDREN’S BEHAVIOR 

Most of the women (77%) had one or more children and most of these children had been 

exposed to the violence. The children were exposed to the violence at an early age with one-third 

of the children exposed for the first time during infancy and 64% exposed by age three. Only 

one-third of the children had received counseling. The violence affected the children’s behavior 

with older children of sexually abused mothers displaying the same degree of depression and 

loneliness as children under treatment. 

Recent research followed a sample of 543 children for over 20 years and found exposure 

to violence between parents the greatest risk of being victimized as an adult (Ehrensaft, Cohen, 

Brown, et al, 2003). Clearly to help children heal from the effects of exposure to violence in the 

home, as well as to prevent victimization as an adult, counseling services must be available, 

affordable, and accessible to all communities. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
40

STUDY CONCLUSIONS 

Two-thirds (68%) of 148 African-American, Hispanic, White, US born and immigrant 

women, applying for a protection order in an urban justice center, reported intimate partner 

sexual assault. Most (79%) of the women reported repeated episodes of forced vaginal, oral and 

anal penetration, with over half (55%) of the women reporting a second sexual assault within one 

month of the first assault. The first episode of sexual assault usually occurred within two years of 

the first consensual sex and was associated with a change in the relationship, most frequently 

increased violence, or a pending or actual separation of the couple. At the time of the sexual 

assaults, 50% of the women reported the abuser was using alcohol, and 40% of the women 

reported the abuser was using illicit drugs, usually crack or cocaine. Over 40% of the women 

reported physical abuse immediately before the sexual assault, and 30% of the women reported 

physical assault immediately afterwards. Fifteen percent of the women reported being threatened 

before and/or after the sexual assaults. For these women sexual assault frequently accompanied 

physical assault and was associated with substance use by the abuser. However, none of the 

women reported the sexual assault to the justice agency at the time of application for a protection 

order. The need for routine assessment by service providers of physically abused women for type 

and frequency of sexual assault followed by guided referral to appropriate agencies is merited by 

this research. 

Compared to the not-sexually abused woman, the sexually assaulted woman reported 

significantly more risk factors of femicide and more episodes of work harassment. These 

findings did not vary by racial or ethnic group or country of birth. Risk factors for femicide were 

highest for African-American women, followed by White women. It is well researched that 

sexual assault coupled with physical assault places a woman in more danger. This research 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
41

revealed a higher number of risk factors of femicide, reported by sexually assaulted compared to 

not-sexually abused women, including strangulation and threats from the abuser to kill the 

woman and hurt the children. Informing sexually assaulted women of their increased likelihood 

of experiencing strangulation and threats, as well as stressing a safety plan and enabling women 

to enact a safety plan, could greatly contribute to enhance health of abused women and their 

children. 

Health consequences of sexual assault reported by the sexually assaulted women included 

vaginal and rectal bleeding, sexually transmitted diseases and pelvic inflammatory disease. 

Gynecological problems were reported significantly more often by women reporting repeated 

sexual assaults. Additionally, one third of the women who reported repeated sexual assaults also 

reported beginning or increasing use of alcohol, nicotine, or illicit drugs because of the sexual 

assaults. Mental health was also affected with 22% of the sexually assaulted women reporting 

they had threatened or tried to commit suicide within 90 days of applying for a protection order 

compared to only 4% of the not-sexually assaulted women. Sexually assaulted women also 

reported significantly more symptoms of post-traumatic stress disorder compared to not-sexually 

abused women, regardless of racial or ethnic group or country of birth. Hispanic and immigrant 

women reported the most symptoms of post-traumatic stress disorder and immigrant women 

reported significantly fewer sources of social support. Offering sexually assaulted women 

information about potential physical and mental health problems and guided referral to assistance 

agencies can potentially minimize or avert the threat of health problems and enhance the health 

and wellbeing of abused women. 

Contact with the justice system, either law enforcement or protection orders, was 

associated with decreasing the risk of re-assault. This reduced risk of re-assault following contact 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
42

with justice services indicates the need for accessible and acceptable justice agencies for women 

such as the Family Justice Center models that include justice, health, counseling, and shelter 

referral within one agency. An integrated agency approach to family violence can potentially 

facilitate early contact of abused women with the services they need and function to interrupt 

existing assault and prevent further abuse. 

STUDY LIMITATIONS 

There are limitations of the study that are important to generalizing the findings. The 

sample used in the study was from one urban agency of women who were actively seeking 

assistance from the justice system. The sample size is small and the study relied on self-reports 

that may under-report or over-report due to lack of inadequate recall or lack of voluntary 

disclosure. None of the information on use of justice or medical services following the sexual 

assaults was validated with justice or medical reports. Additionally, 95% of the non-US born 

women in this study were from Spanish-speaking countries and, hence, Hispanic. How similar or 

dissimilar Hispanic immigrant women are from non-Hispanic immigrant groups is unknown and 

cannot be deduced from this research. Future research is needed with different ethnic and 

immigrant groups on the temporal sequencing of intimate partner sexual assault relative to 

services sought and consequences experienced. 

Additionally, when considering the health outcome data, our study is limited by an 

absence of information about the women’s physical or sexual abuse during childhood. Childhood 

abuse represents a potential confounding factor for later health problems. McCauley and 

associates (1997) found that abused women in a primary care setting, who were abused as 

children, had long-term health consequences over and above what could be attributed to intimate 

partner violence. Another limitation of our study is an absence of trauma history data over the 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
43

woman’s lifetime. Like intimate partner violence, all trauma a woman experiences will affect her 

physical health. Holman and associates (2000) found that 10% of 1456 adults interviewed in a 

primary care clinic had experienced a traumatic event in the last year and that 57% experienced 

at least 1 event in their lifetime. Holman documented the traumatic event history, female gender 

and non-Hispanic ethnicity associated with more psychiatric conditions. Future studies must 

separate physical from sexual assault and examine the interconnections among childhood abuse, 

lifetime trauma and violence, intimate partner violence and physical health problems to better 

understand the effects of these factors on a woman’s health and functioning. 

STUDY IMPLICATIONS FOR HEALTH & JUSTICE PRACTICE

This study found repeated sexual assaults associated with life-threatening consequences 

including sexually transmitted diseases, unintended pregnancy, post-traumatic stress disorder, 

suicide and femicide. If the woman is pregnant and assaulted, both the health of the mother and 

viability of the infant are seriously jeopardized. Contact with the justice system, either police or

civil protection orders, or receiving medical care greatly reduces the likelihood of re-assault. 

Clearly, the need for available, accessible and culturally acceptable justice services, both law 

enforcement and civil protection orders, as well as health services are urgently needed. 

Women must be informed that contact with justice and health services greatly reduces the 

likelihood of re-assault. Routine assessment for sexual assault must be part of standard justice 

and health services, along with information on the associated increased risk for mental health 

problems of post-traumatic stress disorder, substance use, and suicide, as well as physical health 

problems of rape-related pregnancy, sexually transmitted diseases, pelvic inflammatory disease, 

and vaginal, rectal, or urinary bleeding. Guided referrals to agencies that can assist sexually 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
44

assaulted women with existing and potential mental and physical health problems must be part of 

standard justice care. 

 Because sexual assault during pregnancy is recognized as a major threat to maternal 

health and infant viability, it is advised that justice services assess abused women for pregnancy 

status and advise pregnant women to share her sexual assault history with a healthcare provider. 

Pregnant women not receiving health care should be offered referrals for medical care by justice 

personnel. It is also recommended that healthcare providers routinely assess all women for 

intimate partner physical and sexual assault and refer all women reporting assault to justice 

services. 

Finally, most children witness the physical or sexual assault of their mothers, most by age 

three, and most never receive any type of counseling. The need is urgent and immediate for 

available, accessible, acceptable and affordable counseling services for youngsters of assaulted 

women. Mothers must be advised of counseling services for children as part of standard justice 

and health care services. 

STUDY RECOMMENDATIONS 

Justice, health, and social service professionals assisting abused women should routinely: 

• Receive training about the frequency, health and safety consequences of intimate partner 

sexual assault. 

• Assess for type and frequency of sexual assault. 

• Inform women reporting sexual assault about their increased risk of femicide, posttraumatic stress disorder, substance use, and suicide, followed with appropriate referrals 

and safety planning information. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
45

• Offer information about symptoms of post-traumatic stress disorder and suicidal ideation, 

as well as referral agencies for treatment. 

• Inform pregnant women of the increased risk of femicide to women physically or 

sexually assaulted during pregnancy, followed with appropriate referrals and safety 

planning information. 

• Inform mothers of the potential negative effects of domestic violence on their child’s 

behavior, followed with appropriate referrals. 

• Inform immigrant women of the increased risk of post-traumatic stress among non-US 

born women, followed with culturally appropriate referrals and safety planning 

information.

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
46

Exhibit 1. Demographic Characteristics for Women Who Were and Were Not Sexually 

Assaulted by an Intimate Partner 

Characteristic Not Sexually

Assaulted 

Sexually 

Assaulted 

Total Test Statistic

n % n % n %

Ethnicity x(2)=.87,p=.646

African American 14 29.2 35 35.0 49 33.1 

White 12 25.0 27 27.0 39 26.4

Latino/Hispanic 22 45.8 38 38.0 60 40.5

Total 48 100.0 100 100.0 148 100.0

US Born x(1)=.81,p=.367

No 11 22.9 30 30.0 41 27.7

Yes 37 77.1 70 70.0 107 72.3

Total 48 100.0 100 100.0 148 100.0

English Speaking x(1)=.43,p=.511

non English 11 22.9 28 28.0 39 26.4 

English 37 77.1 72 72.0 109 73.6

Total 48 100.0 100 100.0 148 100.0

Ever Employed x(1)=1.03,p=.310 

No 8 16.7 24 24.0 32 21.6

Yes 40 83.3 76 76.0 116 78.4

Total 48 100.0 100 100.0 148 100.0

Education x(1)=3.66,p=.056

Less than HS grad 9 18.8 34 34.0 43 29.1 

At least HS grad 39 81.3 66 66.0 105 70.9 

Total 48 100.0 100 100.0 148 100.0

Income x(3)=1.98,p=.577

0-$10 12 25.5 30 30.0 42 28.6

$10-20 11 23.4 31 31.0 42 28.6

$20-30 14 29.8 22 22.0 36 24.5

>$30 10 21.3 17 17.0 27 18.4

Total 47 100.0 100 100.0 147 100.0

Present relationship? x(3)=2.54,p=.468 

Spouse/Common law 24 50.0 55 55.0 70 53.4 

Ex-spouse/common law 10 20.8 15 15.0 25 16.9 

Boyfriend/girlfriend 2 4.2 10 10.0 12 8.1

Ex-boyfriend/ex-girlfriend 12 25.0 20 20.0 32 21.6

Total 48 100.0 100 100.0 148 100.0

Present relationship? x(1)=1.61,p=.205 

Former 22 45.8 35 35.0 57 38.5

Current 26 54.2 65 65.0 91 61.5

Total 48 100.0 100 100.0 148 100.0

Living with Abuser x(1)=.06,p=.803

No 42 87.5 86 86.0 128 86.5

Yes 6 12.5 14 14.0 20 13.5

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
47

Total 48 100.0 100 100.0 148 100.0

Children x(1)=2.39,p=.122

No 14 29.2 18 18.0 32 21.6

Yes 34 70.8 82 82.0 116 78.4

Total 48 100.0 100 100.0 148 100.0

Exhibit 2. Relationship Status at Intake and 24-Months Later 

Relationship Status 24 Months 

Former Current Total

n % of total n % of total n % 

Intake

Former 53 35.8 4 2.7 57 38.5

Current 43 29.1 48 32.4 91 61.5

Total 96 64.9 52 35.1 148 100.0

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
48

Exhibit 3. Type and Frequency of Sexual Assault Reported by 100 Women

Question: 

How many times did (abuser’s name) 

Never 

% 

Once 

% 

2-3 times 

% 

4 or more 

% 

Make you have sexual intercourse against 

 your will? 

0 18 20 62

Physically forced you to have sex? 9 21 19 51 

Make you have oral sex against will? 63 5 7 25 

Make you have anal sex against your will? 73 14 6 7 

Used an object on you in a sexual way? 94 3 1 2 

Exhibit 3a. Analysis of Variance for mean sexual assault score by ethnicity 

Woman's Ethnicity 

Sexually Abused 

na=35/ nw=27/ 

nl=38 

Ethnicity 

M SD F(df), p

African American 5.37 2.35 F(2,145)=1.42

White 7.22 3.52 p=.246

Latino/Hispanic 5.92 3.46

na=sample size for African American/ nw=sample size for White/ nl=sample size for 

Latino/Hispanic 

Exhibit 3b. Analysis of Variance for mean sexual assault score by country of birth 

Woman’s 

Country of 

Birth 

Sexually 

Abused 

nn=30/ nu=70 

M SD F(df), p

Non-US born 4.1 3.9 F(1,146)=.015,p=.904

US born 4.2 3.8 

nn=sample size for non-US born/ nu=sample size for US born 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 4.Means, Standard Deviations, and Results from One-Way ANOVA of Incidents by Ethnicity and Country 

Incident Ethnicity St

African 

American 

⎯⎯⎯⎯⎯⎯⎯

White 

⎯⎯⎯⎯⎯⎯⎯

Latino/Hispanic

⎯⎯⎯⎯⎯⎯⎯

M SD

M SD

M SD

Number of years from when met abuser to First Forced Sex 4.1 4.9 4.2 4.7 5.7 6.2 F(Number of years from First Sex to First Forced Sex 3.5 4.4 3.8 4.6 5.3 6.5 F(Number of years from First Forced Sex to Additional Forced Sex 0.3 0.6 0.8 2.2 0.3 0.5 F(Number of years from meeting abuser to when Physical Abuse began* 2.6 3.2 2.2 3.0 3.4 3.6 F(

Number of years from meeting abuser to applied for PO in January 2001** 7.7 5.7 12.3 7.9 11.0 9.1 F(

* Women who reported sexual abuse BEFORE physical abuse were 

removed from this analysis 

 ** Women who applied for a protection order before Jan. 2001 were 

removed from this analysis 

Country of Birth 

US Born 

⎯⎯⎯⎯⎯⎯⎯

Non US Born 

⎯⎯⎯⎯⎯⎯⎯

M SD

M SD

Number of years from when met abuser to First Forced Sex 4.0 4.4 6.5 6.8 F(Number of years from First Sex to First Forced Sex 3.4 4.1 6.3 7.2 F(Number of years from First Forced Sex to Additional Forced Sex 0.4 1.4 0.5 0.9 F(Number of years from meeting abuser to when Physical Abuse began 2.3 2.9 3.7 3.8 F(Number of years from meeting abuser to applied for PO in January 2001 9.9 7.6 10.5 8.2 F(

*Non US born significantly higher than US born 

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 

 

 

Exhibit 5. Time Sequencing of Forced Sex 

0

5

10

15

20

25

30

35

PERCEN

T

<1

Y

R

1-2Y

R

2.1-5Y

R

>5yr

s

 Sequencing of Events

Met Abuser to 1st Forced Sex

1st Sex to 1st Forced Sex

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 51

Exhibit 6. Type and Frequency of Relationship Changes 

 Prior to First Sexual Assault 

Relationship Change N (%)

Abuser more violent, possessive or controlling 27 (33)

Emotional separation of couple 18 (22)

Actual or pending separation 14 (17)

Abuser using drugs or alcohol 12 (15)

Abuser having an affair 7 ( 8) 

Pregnancy or post-partum state 4 ( 5) 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 52

Exhibit 7. Abuser Actions during 1st and Add Sexual Assaults 

0

10

20

30

40

50

60

P

ERCENT

Alcohol U

s

e

Drug Use 

Phy Abuse

Before Se

x

Phy Abuse

After S

e

x

Threat

s

Before Se

x

Threats After

Se

x

Abuser Actions 

1st Assault Additional Assaults

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 8. Frequencies for Helpseeking Behavior Stratified By Women Who Were and Were Not Subsequently Se

Helpseeking Behavior After 1st Sexual Assault 

Experienced Subsequent 

Sexual Assault 

Total 

(n=100) 

Further Distribution of Total 

Yes (n=79) No (n=21)

n (%) n (%) n (%) 

Told someone about assault 16 (20.3%) 10 (47.6%) 26 (26.0%) (family/friends=20/other=6) Contacted police 2 (2.5%) 4 (19.0%) 6 (6.0%) (abuser arrested=3/no arrest=3) 

Applied for protection order 2 (2.5%) 6 (28.6%) 8 (8.0%) (received PO=4/no receipt=4) 

Received medical care 5 (6.3%) 4 (19.0%) 9 (9.0%) Received counseling 2 (2.5%) 1 (4.8%) 3 (3.0%) 

*Fisher’s exact test for contingency tables 

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 9. Relative Risk (RR), 95% Confidence Interval (CI), and Interpretation of Effect of Helpseeking Behavio

Subsequent Sexual Assault 

Helpseeking (HS) Behavior After 1st Sexual Assault (SA) RR (95%CI) RR=p1/p2 Interpretation of RR 

Benefit of seeking help as compared to women 

who did not seek help

Consequences of not 

women wh

Told someone about assault 0.72 (0.53,0.99) Women who told were 28% less likely (72% as 

likely) to experience subsequent SA

Women who did not te(1/0.72) to experience 

Contacted police 0.41 (0.13,1.27) Women who contacted police were 59% less

likely to experience subsequent SA 

Women who did not cotimes more likely to ex

Applied for protection order 0.30 (0.09, 1.0) Women who applied for PO were 70% less

likely to experience subsequent SA 

Women who did not aptimes more likely to e

Received medical care 

0.68 (0.38,1.24) Women who received medical care were 32% 

less likely to experience subsequent SA

Women who did not re47% more likely to exp

Received counseling 

0.84 (0.37, 1.88) Women who received counseling were 16% less 

likely to experience subsequent SA 

Women who did not re19% more likely to exp

p1=(Yes performed HS behavior & experienced SA/ Total yes performed HS behavior [example using told someone (16/26)]p2=(No to perform HS behavior but experienced SA/ Total no to perform HS behavior [example using told some ((79-16)/(100-26))]p1/p2 = 0.615/0.851 = 0.72

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 10. Frequencies for Helpseeking Behavior After Subsequent Assault By Women Did and Did Not PerforAfter First Sexual Assault 

Performed Helpseeking Behavior After

FIRST Sexual Assault 

Performed Helpseeking

Behavior After Subsequent

Sexual Assault

Total 

(n=79) 

Further Distribution of Tota

“Yes-Performed helpseeking 

behavior after subsequent

assault” 

Behavior Yes No n (%)

STold someone Yes-told 

someone 

14 (38.9%) 2 (4.7) 16 (20.3) 

No-didn’t tell 

someone 

22 (61.1%) 41 (95.3) 63 (79.7) (family/friends=26/other=10)

Contacted Police Yes-contacted 

police 

2 (16.7%) 0 (0%) 2 (2.5) 

No-didn’t 

contact police 

10 (83.3%) 67 (100.0%) 77 (97.5) (abuser arrested=2/no arrest=1

Applied for Protection Order Yes-applied for 

PO 

0 (0.0%) 2 (3.1%) 2 (2.5) 

No-didn’t 

apply for PO

15 (100%) 62 (96.9%) 77 (97.5) (received PO=10/no receipt=5

Medical care after 1st SA ** Yes-received 

care 

4 (36.4%) 1 (1.5%) 5 (6.4) 

No-didn’t 

receive care 

7 (63.6%) 66 (98.5%) 73 (93.6) 

Counseling after 1st SA Yes-received 

counseling

0 (0.0%) 2 (2.8%) 2 (2.5) 

No-didn’t receivecounseling

7 (100%) 70 (97.2%) 77 (97.5) 

*Fisher’s exact test for contingency tables

**One woman who did not receive medical care after 1st assault is missing response to medical care after subsequent assault 

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 11. Relative Risk (RR), 95% Confidence Interval (CI), and Interpretation of Effect of Helpseeking BehaSubsequent Sexual Assault 

Performed Helpseeking BehaviorAfter Subsequent Assault

Relative 

Risk (RR) 

95% Confidence 

Interval 

Interpretation of RR 

Helpseeking Behavior p1/p2 Lower Upper

Benefit of seeking help as compared to

those who did not seek help after 1st SA 

Consequences of no

pared to those who d

Told someone about assault 2.5 2.5 3.7 Women who told after 1st SA were 2.5 

times more likely to tell after subsequentSA 

Women who did not t

60% less likely to tell 

Contacted police 7.7 4.3 13.7 Women who contacted police after 1st SA 

were 7.7 times more likely to contact police after subsequent SA

Women who did not c

SA were 87% less likafter subsequent SA

Applied for protection order Unable to

compute* 

Received medical care 8.3 3.6 19.1 Women who received medical care after 

1st SA were 8.3 times more likely to

receive medical care after subsequent SA

Women who did not r1st SA were 88% less 

care after subsequent 

Received counseling Unable to 

compute* 

*Unable to compute RR-no women performed the helpseeking behavior after 1st and subsequent sexual assault

p1=(Yes to performed HS behavior both times/ Total Yes to performed HS behavior after 1st SA [example: (14/16)]p2=(No to perform HS behavior after 1st SA but Yes performed HS behavior After subsequent SA/ Total no to perform HS behavior af

p1/p2 = 0.875/0.349 = 2.5

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 12. Mean Violence Scores and Results from Analyses of Variance (ANOVA) and Multivariate ANOVAs 

White, and Latino/Hispanic for Women Who Were and Were Not Sexually Abused by an Intimate Partner at Tim

Order in January 2001 

Violence Score Woman's Ethnicity Sexually Abused 

na=35/ nw=27/ nl=38 

Not Sexually Abused 

na=14/ nw=12/ nl=22 

Abuse Group Ethnicity 

M SD M SD F(df), p F(df), p 

SAVAWSa

Threats African American 29.29 11.77 21.36 15.10 F(2,141)=2.47, F(4,284)=1.

White 28.74 16.45 24.25 16.00 p=.088* p=.308 

Latino/Hispanic 27.11 13.02 26.00 12.30 

Physical Abuse African American 22.80 15.21 11.43 14.75 

White 17.81 16.33 10.92 12.73

Latino/Hispanic 19.21 13.51 19.73 16.36 

Danger African American 6.77 2.22 4.86 2.32 F(1,142)=10.07 F(2,142)=.6

White 6.56 2.29 5.25 2.14 p=.002** p=.511 

Latino/Hispanic 5.82 2.72 4.91 2.43 

Stalking African American 7.29 3.10 7.14 4.50 

White 8.59 4.11 5.75 5.03 F(1,142)=1.71 F(2,142)=.0

Latino/Hispanic 7.18 3.91 7.36 4.09 p=.192 p=.993 

Work Harassment African American 3.24 2.06 1.92 2.02 F(1,110)=5.90 F(2,110)=.9

White 3.83 1.56 2.60 1.96 p=.009** p=.383 

Latino/Hispanic 3.17 1.74 2.94 2.15 

SF12-Health Scoresa

Physical Component Scale African American 44.23 13.78 50.55 13.42 F(2,141)=4.83, F(4,284)=1.

White 46.32 12.73 49.94 10.28 p=.009*** p=.227 

Latino/Hispanic 47.26 12.17 52.36 9.45 

Mental Component Scale African American 28.32 11.70 30.35 10.48 

White 27.45 9.96 39.24 14.03

Latino/Hispanic 28.44 11.57 27.85 8.81 

na=sample size for African American/ nw=sample size for White/ nl=sample size for Latino/Hispanic aMultivariate ANOVA with 2 dependent variables (SAVAWS: threats and physical abuse; SF12: Physical and Mental) 

*Trend for global difference in abuse group yielded the following results for tests of simple effects: threats F(2,142)=3.30,p=.072 & phys** Sexually abused significantly higher than not sexually abused ***Tests of simple effects tests yielded the following results: PCS F(2,142)=5.10,p=.026 & MCS F(2,142)=4.88,p=.029 

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 13. Baseline Mean Violence Scores and Results from Analyses of Variance (ANOVA) and Multivariate ANO

US Born Women Who Were and Were Not Sexually Abused by an Intimate Partner

Violence

Sexually Abused 

nn=30/ nu=70 

Not Sexually Abused

nn=11/ nu=37 

Abuse Group Country of Birth 

M SD F(df), p F(df), p F(df), p F(df), p 

SAVAWSa

Threats Non-US born 24.53 12.18 25.55 8.55 F(2,143)=.663,p=.532 F(2,143)=1.99,p=.14

US born 29.93 13.83 23.81 15.26

Physical Abuse Non-US born 19.93 13.82 19.45 17.22 

US born 20.16 15.44 13.81 14.78

Danger Non-US born 5.63 2.79 5.55 2.70 F(1,144)=3.99,p=.048* F(1,144)=.084,p=.76

US born 6.66 2.25 4.81 2.16

Stalk Non-US born 6.13 3.58 7.36 3.85 F(1,144)=.023,p=.879 F(1,144)=.881,p=.35

US born 8.23 3.62 6.76 4.60

Work Harassment Non-US born 2.90 1.74 3.00 2.20 F(1,112)=1.32,p=.253 F(1,112)=.015,p=.90

US born 3.57 1.83 2.44 2.05

SF12-Health Scoresa

Physical Component Score Non-US born 46.03 12.95 53.85 7.53 F(2,143)=3.14,p=.046** F(2,143)=.875,p=.41(norm at75th %=56.0) US born 45.92 12.89 50.44 11.51 

Mental Component Score Non-US born 29.33 12.08 26.23 9.73 (norm at75th %=56.9) US born 27.62 10.71 32.97 11.69 

nn=sample size for non-US born/ nu=sample size for US born aMultivariate ANOVA with 2 dependent variables (SAVAWS: threats and physical abuse; SF12: Physical and Mental) 

*Overall, danger scores from sexually abused women were significantly higher than women who were not sexually abused. **Overall a significant abuse group main effect. Follow-up tests showed women who were not sexually abused had significantly (F(1,144)=6

component scores. 

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 14. Table of Frequencies of Women Who Reported “Yes” to Danger Behaviors of Femicide By Sexual Abuse Gro

Not Sexually Abused

(n=48) 

Sexually Abused

 (n=100)

n % n %

Within the last three months: 

Has the physical violence increased in frequency? 26 (54.2) 65 (65.0) 

Has the physical violence increased in severity? 26 (54.2) 66 (66.0) Has the person tried to choke you? 15 (31.3) 47 (47.0) Is there a gun in your house? 9 (18.8) 17 (17.0) Has this person used drugs? 15 (31.3) 53 (53.0) Has this person threatened to kill you? 28 (58.3) 76 (76.0) Has this person been drunk every day? 14 (29.2) 45 (45.0) Does this person control most or all of your daily activities? 29 (60.4) 72 (72.0) If pregnant, df=1, did this person beat you? 1 (2.1) 7 (7.0) 

Has this person been violently and constantly jealous of you? 38 (79.2) 88 (88.0) 

Have you threatened or tried to commit suicide? 2 (4.2) 22 (22.0) Has this person threatened or tried to commit suicide? 18 (37.5) 41 (41.0) 

Has this person been violent outside the home? 25 (52.1) 63 (63.0) 

Does this person have a gun? 21 (43.8) 33 (33.0) Has this person threatened to harm the children? 2 (4.2) 19 (19.0) 

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 15. Mean Psychological Scores Assessed at 24 Months After Application for a Protection Order and ResulVariance (ANOVA) and Multivariate ANOVAs for African American, White, and Latino/Hispanic for Women W

Sexually Abused by Intimate Partner 

Violence Score Woman's Ethnicity Sexually Abused

na=35/ nw=27/ nl=38 

Not Sexually Abused

na=14/ nw=12/ nl=22 

Abuse Group Ethnicity 

M SD M SD F(df), p F(df), p 

BSI: Global Index African American 53.0 12.6 50.4 12.3 F(1,142)=1.69, F(2,142)=.0(at risk >63) White 55.0 12.7 49.5 12.0 p=.195 p=.983 

Latino/Hispanic 52.3 11.5 51.8 11.7

BSI:a (at risk 2 scales>63)

Depressed African American 53.1 11.8 50.6 11.2 F(3,140)=.73, F(6,282)=.4

White 53.1 12.0 52.4 11.9 p=.533 p=.533 Latino/Hispanic 52.7 10.6 52.7 9.6

Anxiety African American 52.6 10.6 51.3 12.8

White 56.6 11.9 50.9 14.5Latino/Hispanic 52.4 11.4 53.0 10.6

Somatization African American 52.3 12.5 51.0 12.6

White 53.2 9.9 48.2 8.9

Latino/Hispanic 50.8 10.5 49.5 9.5

Medical Outcomes Study African American 40.57 8.52 43.93 5.33 F(1,142)=3.33 F(2,142)=1.

White 39.52 9.56 43.25 9.10 p=.070 p=.189 

Latino/Hispanic 38.24 9.85 39.86 8.10

Posttraumatic Stress Disorder African American 3.31 2.11 3.43 2.34 F(1,142)=5.58, F(2,142)=6.(have PTSD>4) White 3.96 1.99 2.08 1.88 p=.020* p=.003** 

Latino/Hispanic 4.95 2.14 4.05 2.01

Family Hardiness Index African American 46.63 10.48 49.08 7.80 F(1,141)=2.04, F(2,142)=.4(normed mean=47.4,SD=6.7) White 42.44 14.00 48.92 7.53 p=.156 p=.633 

Latino/Hispanic 47.24 7.01 45.86 7.72

na=sample size for African American/ nw=sample size for White/ nl=sample size for Latino/Hispanic aMultivariate ANOVA with 3 dependent variables (BSI: depressed, anxiety, somatic) 

* Sexually abused significantly different than not sexually abused **Overall, regardless of abuse group, Latinos experienced significantly greater PSTD scores than African American (p=.005) and White 

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Table 16. Mean Psychological Scores Assessed at 24 Months and Results from Analyses of Variance (ANOVA) afor US Born and Non-US Born Women Who Were and Were Not Sexually Abused by an Intimate Partner

Violence Score Country 

Sexually 

Assaulted 

nn=30/ nu=70 

Not Sexually 

Assaulted 

nn=11/ nu=37 

Assault Group Country of Birth 

M SD F(df), p F(df), p F(df), p F(df), p 

BSI: Global Non-US born 52.7 10.5 52.2 9.3 F(1,144)=.53,p=.467 F(1,144)=.03,p=.862 (at risk >63) US born 53.6 12.6 50.4 13.3

BSI: a (at risk-2 subscales >63)

Depression Non-US born 53.6 10.0 51.6 9.8 F(3,142)=.49,p=.691 F(3,142)=.19,p=.905 

US born 52.7 11.9 52.1 10.8

Anxiety Non-US born 51.4 10.1 53.0 8.8

US born 54.6 11.7 51.7 13.0

Somatization Non-US born 52.1 9.9 49.6 10.4

US born 51.9 11.5 49.6 10.2

Medical Outcomes Study Non-US born 36.87 9.98 37.27 10.39 F(1,144)=.82,p=.366 F(1,144)=7.46,p=.00

US born 40.49 8.82 43.27 6.33

Posttraumatic Stress Disorder Non-US born 5.40 1.96 5.09 1.76 F(1,144)=1.49,p=.224 F(1,144)=24.59,p<.0(have PTSD>4) US born 3.56 2.05 2.86 2.06

Family Health Index Non-US born 44.27 9.18 45.18 8.89 F(1,143)=.498,p=.481 F(1,143)=1.68,p=.19(normed mean=47.4,SD=6.7) US born 46.36 11.11 48.25 7.28 

nn=sample size for non-US born/ nu=sample size for US born aMultivariate ANOVA with 3 dependent variables (BSI: depressed, anxiety, somatic) 

*US born significantly higher than non-US born**Non-Us born significantly higher than US born

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
Exhibit 17. Table of Frequencies of Women Who Reported “Yes” to Post Traumatic Stress Disorder Symptoms By Abuse G

Not Sexually Abused

(n=48) 

Sexually Abused

 (n=100)

n % n %

Post Traumatic Stress Disorder Symptom

Made a special effort to avoid thinking or talking about what happened 25 (52.1) 67 (67.0) 

Much less interested in doing things 17 (35.4) 42 (42.0) 

Felt distant or cut off from others 21 (43.8) 49 (49.0) 

Felt "numb" or as if you no longer had strong feelings 17 (35.4) 48 (48.0) Notice a change in the way you think about or plan for the future 39 (81.3) 87 (87.0) 

Had trouble falling or staying asleep 20 (41.7) 58 (58.0) 

Been jumpy or easily startled 23 (47.9) 60 (60.0) 

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 

 

 

Exhibit 18. Victim Health Problems Following One Sexual Assault vs multiple assaults

Health Problem One Assault

 (N=21)

>1 Assault 

 (N=79)

 Total 

(N=100)

N ( %) N ( %)

Pregnancy 2 (10) 18 (23) 20 

Bacterial Vaginosis 0 10 (13) 10 

Chlamydia 0 9 (11) 9 

Crabs 0 2 (3) 2 

Genital herpes 0 5 (6) 5 

Genital warts 0 3 (4) 3 

Gonorrhea 0 6 (8) 6 

HIV/AIDS 0 0 0 

Pelvic Inflammatory Disease 0 7 (9) 7 

Trichomoniasis or yeast infection 1 (5) 24 (30) 25 

Bleeding from vagina 1 (5) 16 (20) 17 

Bleeding from rectum 0 16 (20) 16 

Hematuria 0 5 (6) 5 

Attempted suicide 0 5 (6) 5 

Began or increased substance use 2 (10) 26 (33) 28 

Began or increased alcohol use 2 (10) 21 (27) 23 

Began or increased nicotine use 2 (10) 17 (22) 19 

Began or increased illicit drug use 0 7 (9) 7 

Problems with intimacy & sexual functioning 4 (20) 17 (22) 21 

Anxiety and depression 2 (10) 21 (27) 30 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 64

Exhibit 19. Type & Frequency of Decision Making About Having Sex, Condom Use & Birth Control 

Decision Sexual Assault 

 N=100 

No Sexual Assault 

 N=48

Test Statistic 

Having Sex Woman = 1% 

Abuser = 56%

Mutual = 43%

Woman = 2% 

 Abuser = 23% 

 Mutual = 75% 

χ2

(2)=14.3, p=.001 

Using birth control Woman = 74%

Abuser = 10%

Mutual = 16%

Woman = 68% 

 Abuser = 5% 

 Mutual = 27% 

χ2

 (2)=3.5,p=.176 

Using condoms Woman = 46%

Abuser = 22%

Mutual = 32%

Woman = 33% 

 Abuser = 8% 

 Mutual = 58% χ2

 (2)=10.2,p=.006 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 65

Exhibit 20. Type & Frequency of Actions Surrounding Birth Control, Condoms, & Pregnancy

Action Sexual 

Assault 

 N=100 

 

No Sexual 

Assault 

 N=48

Test Statistic 

Ever Used Birth Control Yes= 63% Yes=58% χ2

 (1)=.29,p=.585 

If no to Birth Control, Reason: 

• Sterility 

• Abuser refused to use 

• Woman’s decision not to use 

Yes = 43% 

Yes = 16% 

Yes = 41% 

Yes = 55% 

Yes = 0 

Yes = 45% 

χ2

 (2)=3.68,p=.159 

Woman wanted to use 

 condoms to prevent STDs 

Yes= 69% Yes= 50% χ2

 (1)=5.01,p=.025 

If yes to wanted condoms, Frequency 

of use: 

• Never 

• Rarely 

• Some of the time 

• Most of the time 

• All of the time 

Yes= 22% 

Yes= 17% 

Yes = 23% 

Yes = 20% 

Yes = 17% 

Yes= 13% 

Yes= 21% 

Yes = 42% 

Yes = 13% 

Yes = 13% 

χ2

 (4)=3.93,p=.415 

If no to wanted condoms, Reason: 

• No perceived threat of STD’s 

• Abuser refused to use 

• Woman did not want to use 

• Never discussed. Not an issue 

Yes= 19% 

Yes= 25% 

Yes = 15% 

Yes = 42% 

Yes= 30% 

Yes= 9% 

Yes = 17% 

Yes = 44% 

χ2

 (3)=5.92,p=.116 

Ever Pregnant because abuser 

would not use birth control 

Yes= 26% Yes = 5% χ2

 (1)=8.9,p=.003 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 66

Exhibit 21. Child Age at First Exposure to Physical or Sexual Assault of the Mother for 200 

Children* 

 

Age of First Exposure N %

<1 year 73 36 

1-3 55 28 

4-9 50 25 

10-20 22 11 

*

Five mothers could not remember the age of child at first exposure 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 67

Exhibit 22. Child’s Age at First Exposure to Assault of Mother 

0

5

10

15

20

25

30

35

40

P

ERCENT

<1 Yr

1-3 Yrs

4-9 Yrs

10-20 Yrs

Child Age at First Exposure to

Abuse

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 68

Exhibit 23. Marginal Means (M), Standard Errors (SE)a

, Raw Group Differences (DIF), and 

Standard Effect Sizes (SEF) for Instruments with Internal (INT), External (EXT), and Total 

Behavior Problems (TBP) Administered to Mothers of 1.5-5 yr olds and Mothers of 6-18 yr 

olds 

Sexually Abused Not Sexually 

Abused 

DIF SEF 

n M SE n M SE 

Instrument for 1.5-5 yrs 

INT 25 53.44 2.74 24 49.25 2.80 4.19 0.31 

EXT 25 55.44 2.25 24 51.46 2.30 3.98 0.35 

TBP 25 56.20 2.51 24 50.83 2.56 5.37 0.42 

Instrument for 6-18 yrsb

INT 

6-11 yrs 34 53.21 1.94 25 53.12 2.26 0.09 0.01 

12-18 yrs 22 61.91 2.41 11 51.00 3.41 10.91 0.88 

EXT 

6-11 yrs 34 55.44 1.76 25 54.08 2.06 1.36 0.15 

12-18 yrs 22 55.55 2.19 11 55.36 3.10 0.18 0.02 

TBP 

6-11 yrs 34 52.59 1.74 25 51.16 2.03 1.43 0.15 

12-18 yrs 22 58.05 2.17 11 51.09 3.07 6.95 0.59 a SE Accounts for variation and sample size 

b

Overall Significant Multivariate Abuse Group by Age Group Interaction; Follow-up 

Univariate interaction for Internal Behaviors was just past significance (p=.038), indicating 

that INT scores for 12-18 yr old youth from Sexually Abused Mothers was nearly 

significantly higher than scores for youth from Not Sexually Abused Mothers 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 69

Exhibit 24. Internal (INT), External (EXT), and Total Behavior Problem (TBP) Scores 

Stratified by Age Group and Gender for Children from Sexually Abused Women and NonSexually Abused Women with Children Scores from Sexually Abused Mothers Compared to 

a Clinically Referred and Non-Referred Normative Sample 

Sexually 

Abused 

Not Sexually 

Abused 

Clinically 

Referred 

Normative Sample

Clinically NonReferred Normative 

Sample 

n M(SD) M(SD) M(SD) M(SD) 

INT: 

11⁄2-5 yrsa 24 53.0 (16.1) 9 53.4 (12.7) 61.2 (10.9)** 50.2 (10.0) 

6-11yrs : Boys 15 53.0 (11.9) 6 56.7 (6.4) 61.7 (11.8)** 50.2 (9.6) 

 Girls 15 51.7 (10.6) 9 52.8 (11.9) 61.4 (10.9)* 50.1 (9.7) 

12-18 yrs:Boys 11 60.5 (12.7) 4 53.8 (5.3) 61.5 (11.1) 50.5 (9.7)** 

 Girls 10 62.6 (12.3) 6 48.8 (12.9) 62.0 (11.5) 50.1 (10.0)** 

Total 75 55.1 (13.6) 34 53.1 (10.6) 

EXT: 

11⁄2-5 yrsa

 24 55.7 (12.1) 9 52.2 (11.3) 57.3 (13.4) 50.2 (9.9)** 

6-11yrs : Boys 15 56.9 (8.5) 6 58.7 (2.3) 62.5 (11.6)** 49.9 (9.8)* 

 Girls 15 52.9 (10.6) 9 50.6 (9.4) 61.2 (12.3)* 50.0 (9.6) 

12-18 yrs:Boys 11 55.7 (13.6) 4 53.5 (5.8) 62.6 (10.7) 50.5 (9.7) 

 Girls 10 55.9 (12.3) 6 54.8 (14) 62.8 (11.4) 50.8 (9.8) 

Total 75 55.4 (11.2) 34 53.5 (9.7) 

TBP: 

11⁄2-5 yrsa

 24 56.1 (14.6) 9 53.3 (12.3) 61.7 (11.1) 50.1 (9.9) 

6-11yrs : Boys 15 52.8 (9.8) 6 55.3 (2.6) 64.4 (10.7)* 50.0 (9.9) 

 Girls 15 51.2 (10.4) 9 50.2 (6.7) 63.8 (11.3)* 50.1 (9.9) 

12-18 yrs:Boys 11 57.3 (12.0) 4 50.8 (5.6) 64.0 (9.5) 50.5 (9.8) 

 Girls 10 58.7 (12.5) 6 50.3 (14.8) 63.0 (10.9) 50.4 (10.1) 

Total 75 55 (12.2) 34 52.0 (9.4) 

Significantly different from normative sample (*p < .01; ** p < .05) 

 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
 70

Investigators’ Biosketch 

Dr. Judith McFarlane is the Principal Investigator of this research and also the Parry 

Chair in Health Promotion and Disease Prevention at Texas Woman’s University, College of 

Nursing, in Houston, Texas. Dr. McFarlane conducts research on the health effects of 

violence against women and the effectiveness of interventions to prevent further violence. Her 

research has been funded by the Centers for Disease Control, National Center for Injury 

Prevention, Agency for Health Research & Quality, The National Institutes of Justice, and the 

National Institutes of Mental Health. Dr. McFarlane began studying intimate partner violence 

during pregnancy in 1984 and has since authored many studies on abuse of pregnant women 

and its connection with low birthweight. Her research findings have been presented to 

congressional committees, included in national health objectives, and used by clinicians in the 

U.S. and abroad to set standards of care for pregnant women. To improve access to early 

prenatal care for high-risk Hispanic women, the W.K. Kellogg Foundation funded Dr. 

McFarlane to design and test the program De Madres a Madres, a health care delivery model 

featured in TIME Magazine and excerpted on NBC “TODAY” show. Dr. McFarlane is the 

author or coauthor of six clinical nursing textbooks and more than 130 peer reviewed journal 

articles on women’s health. Dr. McFarlane presents regularly to national and international 

audiences. 

Dr. Ann Malecha is the Co-Principal Investigator of this research and also an Assistant 

Professor at Texas Woman's University, College of Nursing in Houston, Texas. Dr. Malecha’s 

research program focuses on improving the health and safety outcomes of abused women. 

Utilizing her experience as an adult nurse practitioner and nurse researcher, Dr. Malecha is 

studying the practice and policy implications of universal screening for domestic violence in 

health care settings. Selected as a Chancellor’s Research Fellow for 2002-2004 at Texas 

Woman’s University, Dr. Malecha is studying the outcomes of domestic violence screening in 

the occupational health setting. Dr. Malecha is the author or coauthor of more than 30 

publications that focus on improving the health of abused women. 

Drs McFarlane and Malecha were assisted by the following people in data collection: Dr. 

Julia Gist, an assistant professor at Texas Woman’s University, Drs. Iva Hall and Sheila 

Smith at the Nursing Department of Lamar University in Beaumont Texas and Ms Elizabeth 

Batten, a bilingual caseworker at the Harris County District Attorney’s Office in Houston. 

Finally, Ms Kathy Watson, statistician at Baylor College of Medicine in Houston completed 

the data analysis. 

This project was supported by Grant No. 2002-WG-BX-0003, awarded by the National 

Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Points of view in 

this document are those of the authors, Dr. McFarlane and Malecha, and do not necessarily 

represent the official position or policies of the U.S. Department of Justice. 

The authors wish to thank the Family Criminal Law Division of the Harris County District 

Attorney’s Office for assistance in the collection of data. We also acknowledge the 148 

women who completed this two year study and the two women who died during the course of 

this study. 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
SEXUAL ASSAULT AMONG INTIMATES: 

FREQUENCY, CONSEQUENCES & TREATMENTS 

Grant No. 2002-WG-BX-0003 

BIBLIOGRAPHY 

Dr. Judith McFarlane, Principal Investigator 

Dr. Ann Malecha, Co-Principal Investigator 

This document is a research report submitted to the U.S. Department of Justice. This report has not 

been published by the Department. Opinions or points of view expressed are those of the author(s) 

and do not necessarily reflect the official position or policies of the U.S. Department of Justice. 
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