TRAUMATIC SYNDROMES OF INCESTUOUS AND NON-INCESTUOUS RAPE
Jean-Michel DARVES-BORNOZ
The role played by sexual assaults in the onset of mental disorders is a point which has long been
debated in psychiatry. And yet disbelief and ignorance of the facts have long hampered the development of
research and therapeutic treatments in this area.
This work first provides a historic overview of the notion of psychological trauma of sexual origin and
then describes the typology of trauma in sexual abuse. The main points concerning the epidemiology of sexual
abuse are then dealt with. Indeed, over the past decade, major epidemiological surveys have reported high
levels of sexual abuse taking place in childhood or adulthood.
Four clinical studies are presented investigating the psychopathological aftermath of incestuous or
non-incestuous rape.
The first of these is a year-long prospective study involving one hundred and two subjects over
thirteen years of age who were victims of incestuous or non-incestuous rape, and who presented consecutively
in the forensic center for victims of rape and incest, within the department of gynecology at the University
teaching hospital in Tours, France (chapter IV). The subjects were regularly interviewed by a psychiatrist using
a standardized battery of clinical instruments for the diagnosis of mental disorders, and more generally for the
assessment of their clinical condition. This study showed that three traumatic syndromes were very frequently
observed following rape. These we called :
1. Syndrome Secondary to Traumatic Stress : this nosographic entity was previously termed traumatic
neurosis, and is elsewhere called Post-Traumatic Stress Disorder (PTSD) ;
2. Dissociative and Phobic Traumatic Syndrome : this syndrome includes somatoform disorders and
specific phobias, but also and especially dissociative disorders, in Pierre Janet's meaning of that term, and
agoraphobia ;
3. Borderline-like Traumatic Syndrome : this syndrome accounts for the alteration in identity and
personality, secondary to the narcissistic wound caused by rape.
We moreover determined that the early onset of one of these two latter syndromes, the incestuous nature of the
rape and experiences of physical violence apart from rape were factors predictive of chronic Post-Traumatic
Stress Disorder one year after rape.
This work further presents specific studies giving an account of the clinical forms of disorders
following rape, in incestuous rape, in adolescents, in males and psychiatric patients :
1. for incestuous rape (chapter V), the Tours cohort is studied from this point of view ;
2. for adolescents (chapter VI), firstly those subjects from the Tours cohort are presented for whom
rape took place before the age of twenty (78% of the cohort) ; next INSERM1 survey data on rape in
adolescence are presented, as studied Marie Choquet, Jean-Michel Darves-Bornoz and Sylvie Ledoux ; the
INSERM survey was carried out using a representative sample of 8255 teenage schoolgoers from the general
population ;
3. for rape in males (chapter VII), the results from the Tours cohort are presented first ; data on rape in
boys as found in the INSERM survey by Marie Choquet, Jean-Michel Darves-Bornoz and Sylvie Ledoux are
then presented ;
4. for the psychiatric patients (chapter VIII), two systematic studies are presented. The first deals with
ninety women suffering from schizophrenia and bipolar disorder. The second study deals with ninety women
consecutively admitted to the Psychiatric Department in the Tours University Hospital. This study attempts to
explain why psychiatric patients as a whole, and whatever their initial diagnosis may be, are frequently rape
victims, and so with a comorbidity frequently presenting the three above-mentioned syndromes.
The work then shows that several approaches (neuropsychological, psychodynamic, behavioral and
psychobiological) can contribute to an understanding of the etiology in these disorders. Finally, different
methods of treating the victims are considered, and the principles applied at the Victims of Psychological
Trauma Consultation Unit at the University Teaching Hospital in Tours, set up by Jean-Michel Darves-Bornoz
in 1992, are illustrated through a single case study (chapter X).
The work firmly concludes that rape and incest form part of the more general field of trauma.
However, it is also noted that, in rape and incest, it is a narcissistic wound that causes the trauma, and that it is
the subject's psychological survival that is at stake. The significant change in impact of the trauma can
therefore be linked to both its specific cause and target.
1. National Institute of Health and Medical Research