Citation

Isaacs R. Pathology 2020; 52(Suppl 1): S22-S23.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.pathol.2020.01.103

PMID

unavailable

Abstract

Sexual assault is a highly traumatic experience. The cognitive, physiological and behavioural responses of the victim during the assault, immediately following, and sometime later at forensic medical assessment may appear counter-intuitive. Tonic immobility, being 'paralysed' or 'frozen' in response intense fear, is an involuntary state of motor inhibition with muscle hyper- or hypo-tonicity, tremor, lack of vocalisation, analgesia and relative unresponsiveness to external stimuli. Memory is generally preserved. Dissociation may be present. Executive cognitive functions may be affected by trauma for some time so that the patient, in retrospect, does not understand and blames themselves for a lack of assertive action. At medical examination the demeanour of the patient may range from overt distress, to emotional containment, to giggly or quiet minimisation, to anger, to dissociation. Experienced examiners recall patients whose seemingly incongruous emotional reaction occasioned doubts in the health care team or police, yet later police investigation later established the facts as recounted by the patient.

Patients may integrate explanation, that is psychoeducation, into understanding their own responses to trauma.

A cultural tendency to minimise, disbelieve or blame the victim of rape persists. Forensic examiners may have a role in assisting the courts in understanding this medical information.

Language: en