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Tonic immobility during sexual assault - a common reaction predicting posttraumatic stress disorder and severe depression
Abstract
Introduction:
Active resistance is considered to be the "normal" reaction during rape. However, studies have indicated that similar to animals, humans exposed to extreme threat may react with a state of involuntary, temporary motor inhibition known as tonic immobility. The aim of the present study was to assess the occurrence of tonic immobility during rape and subsequent posttraumatic stress disorder and severe depression MATERIAL AND METHODS: Tonic immobility at the time of the assault was assessed using the Tonic Immobility Scale in 298 women who had visited the Emergency clinic for raped women within 1 month of a sexual assault. Information about the assault and the victim characteristics were taken from the structured clinical data files. After 6 months, 189 women were assessed regarding the development of posttraumatic stress disorder and depression RESULTS: Of the 298 women, 70% reported significant tonic immobility and 48% reported extreme tonic immobility during the assault. Tonic immobility was associated with the development of posttraumatic stress disorder (OR 2.75; 1.50-5.03, p = .001) and severe depression (OR 3.42; 1.51-7.72, p = .003) at 6 months. Further, prior trauma history (OR 2.36; 1.48-3.77, p <.001) and psychiatric treatment history (OR 2.00; 1.26-3.19, p = .003) were associated with the TI response CONCLUSIONS: Tonic immobility during rape is a common reaction associated with subsequent posttraumatic stress disorder and severe depression. Knowledge of this reaction in sexual assault victims is important in legal matters and for health care follow-up. This article is protected by copyright. All rights reserved.
... In humans, TI has been analyzed in reactions to traumatic events (Abrams et al., 2009;Bados et al., 2008;Lloyd et al., 2019;Reichenheim et al., 2014). It is composed of two conditions-fear and physical restraint- (Heidt et al., 2005;Kozlowska et al., 2015) and consists of different symptoms such as pronounced physical and verbal immobility, trembling, muscle stiffness, intermittent eye closure, sensations of coldness and numbness, and insensitivity to intense or painful stimuli (Coxell & King, 2010;Marx et al., 2008;Suarez & Gallup, 1979). ...
... However, most of the literature on this subject has focused on the study of the reactions of women who have experienced an episode of sexual violence (Covers et al., 2022;Fusé et al., 2007;Marx et al., 2008;Suarez & Gallup, 1979), which has come to be known as "rape-induced paralysis" (Gallup et al., 1976). ...
... While sexual violence is one of the most traumatic experiences a person can endure (Galliano et al., 1993), the experience of TI in these victims is also traumatic in itself. The researchers Marx et al. (2008) have found that 47% of a sample of rape victims reported their experience of TI as being extremely frightening. ...
Tonic immobility (TI) is a state of temporary, involuntary motor inhibition that occurs in states of intense fear and has been studied among victims of sexual violence. Studies on TI are scarce and mainly focus on rape victims. The present study is a literature review of research that has examined TI in women victims of sexual violence. A database search was carried out using the Preferred data elements for systematic reviews and meta-analyses (PRISMA) method. In order to be included in the analysis, the manuscripts had to deal exclusively with research involving samples of subjects and the study analyzed TI in victims of sexual violence. In all, 11 manuscripts met the above criteria and were included in the review. Research describes that TI is characterized by two factors: fear and immobility. Quantitative research was conclusive in affirming the presence of a state of paralysis and fear in TI. The immobility factor is the determining factor in explaining the victim's lack of defense or resistance and causes effects such as trembling, physical and mental paralysis, inability to vocalize, and eye closure. In addition, TI has been correlated with long-term negative clinical manifestations as victims are more likely to suffer from post-traumatic stress disorder. These findings contribute to an understanding of TI in victims of sexual violence. Therefore, legal and care practitioners must be able to recognize TI to understand the victim's behavior, differentiate it from consent, and to be able to assist in their recovery.
... The most often used instrument to measure TI is the 10-item Tonic Immobility Scale Forsyth et al., 2000). The 10-dimensional items of the TIS include components related to the tonic immobility factor (seven items) and the fear factor (three items, Fiszman et al., 2008;Massazza et al., 2021;Möller et al., 2017;Van Buren & Weierich, 2015). Additionally, shortened versions of the TIS have been validated, some of which exclude the fear factor-related items and focus on the motor aspects of TI, as the seven-item TIS de Kleine et al., 2018), the five-item TIS (Bados et al., 2015), and the four-item TIS, in which the authors' goal was to avoid the risk of conceptual overlap with PD (Rocha-Rego et al., 2009). ...
... We found two studies investigating the relationship between TI and increased risk of PTSD development upon trauma exposure (Gama et al., 2022;Möller et al., 2017) and three studies investigating the Records identified from databases (k=2878): ...
... p < .01). Möller et al. (2017) conducted the only study that assessed TI shortly after the traumatic event (mean: 19 days), showing that the prevalence of a PTSD diagnosis six months after trauma was almost three times higher for those who experienced TI compared to those who did not (OR: 2.75, 95% CI: 1.50-5.03, p < .01). ...
BACKGROUND: Tonic immobility (TI) is a reflexive, involuntary response that causes motor inhibition, vocal suppression, and analgesia. TI is elicited by extreme fear and perception of entrapment in a life-threatening situation. Research suggests that TI is a frequent peritraumatic response and may be related to subsequent posttraumatic stress disorder (PTSD). However, findings are mixed and, as of yet, no systematic or meta-analytic review examining associations between TI and PTSD has been published.
OBJECTIVE: We systematically and meta-analytically reviewed the literature and investigated whether TI is associated with the development, severity, and course of PTSD. Additionally, we evaluated whether different types of traumatic events are differentially associated with TI, and whether TI severity differs according to sex.
METHODS: A systematic literature search was conducted using Embase, PubMed, PsycINFO, and Scopus. Meta-analyses were performed on the included articles.
RESULTS: We identified 27 eligible articles. We found a significant association between TI and PTSD symptom severity (r=0.39, 95% CI: 0.34 to 0.44; p<.0001). TI was more severe among females (Cohen’s d=0.37, 95% CI: 0.25 to 0.48; p<.0001) and was more often elicited in situations involving interpersonal violence. We found limited longitudinal data to perform a meta-analysis of the association between TI and the development and/or course of PTSD. However, the literature available seems to support the role of TI in both the development and course of PTSD.
CONCLUSIONS: Peritraumatic TI is associated with PTSD symptom severity, occurs more often during interpersonal violence, and is more severe among females. More longitudinal research is needed to investigate the role of TI in psychopathology development and course.
... Tonic immobility (TI) is one of the immediate consequences of rape experienced by most survivors of the abuse, and other traumatic events (Boscarino, 2004;Duma, 2016aDuma, , 2016bMachisa et al., 2017;Moller et al., 2017;TeBockhorst et al., 2015). It is prevalent amongst female victims, and is often associated with post-traumatic stress disorder (Adeola, 2009;Kuiling et al., 2019;Norte et al., 2019). ...
... It is prevalent amongst female victims, and is often associated with post-traumatic stress disorder (Adeola, 2009;Kuiling et al., 2019;Norte et al., 2019). Moller et al. (2017), reported that the percentage of raped women who experienced TI rose to 70% from the 37% by Galliano et al. (1993) and 52% reported by Heidt et al. (2005). TI has been described as a behavioural response, "…to an inescapable threat, or a strategy of last resort, when active defence responses have failed" (Kozlowska et al., 2015). ...
... There is little or no research reported, however, on the lived experiences of TI among rape survivors, especially in Nigeria (Akinlusi et al., 2014;Sodipo et al., 2018); although, it has been studied, among birds in Nigeria (Akpa et al., 2007;Egbuniwe et al., 2016;Sinkalu et al., 2016). This dearth of relevant literature on TI among human victims of rape in Nigeria has resulted in its non-inclusion as critical medico-legal management and care of rape survivors, related policies, management protocols (Moller et al., 2017) and research. The implication of this is that the limited knowledge about manifestations suggestive of the phenomenon of TI experienced by rape victims could result in mismanagement and secondary victimisation. ...
Tonic immobility is considered the last involuntary self-protecting act/mechanism experienced by victims of rape when they are under attack. It is associated with trauma related mental health risks post-rape. Despite this, tonic immobility has not received priority as an area of research on Nigerian female victims of rape. As a result, little has been known about this phenomenon by nurses and other professionals who are involved in the care and management of rape survivors in Nigeria. The limited knowledge about tonic immobility as a phenomenon might have resulted in mismanagement and secondary victimization of rape victims experiencing manifestation suggestive of tonic immobility during or after rape. This study was a qualitative narrative inquiry that explored, analysed, and interpreted the lived experiences suggestive of tonic immobility, and the meaning attached to such experiences by victims. A sample of fourteen Nigerian women who self-identified as rape victims was utilized. Individual semi-structured, in-depth interviews were conducted to generate data. Thematic data analysis revealed four overarching themes: namely (i) Tonic immobility as an Altered Physical State, (ii) Tonic Immobility as Mental Paralysis, (iii) Painful Loss of Self-defence, and (iv) Constant Self-blame. The findings provided an insight into the traumatic experience of raped women and the psychological implication of tonic immobility as extreme defence mechanism. This study will prove invaluable to nurses and other professionals/stakeholders involved in the care and management of rape victims; to help them develop and use appropriate strategies for management and prevention of secondary victimisation.
... Seis estudos (Himmelfarb, Yaeger, & Mintz, 2006;Kang, Dalager, Mahan, & Ishii, 2005 (Himmelfarb, Yaeger, & Mintz, 2006;Lončar, Medved, Jovanović, & Hotujac, 2006;Möller, Söndergaard, & Helström, 2017;Oyola, Guardiola, Carvajal, & Torre, 2017) apresentaram uma amostra totalmente do sexo feminino, enquanto os outros dois (Kang, Dalager, Mahan, & Ishii, 2005;Monteith, Menefee, Forster, & Bahraini, 2016) tiveram uma amostra com ambos os sexos. ...
... Além disso, é possível verificar a nota atribuída para cada estudo incluído, referente à qualidade metodológica. A maioria dos artigos (Himmelfarb et al., 2006;Kang et al., 2005;Möller et al., 2017;Monteith et al., 2016) apresenta um baixo risco de viés, enquanto dois estudos (Lončar et al., 2006;Oyola et al., 2017) foram classificados com alto risco de viés. A tabela 2 representa os diagnósticos reportados pelos artigos incluídos. ...
... A tabela 2 representa os diagnósticos reportados pelos artigos incluídos. Cinco (Himmelfarb et al., 2006;Kang et al., 2005;Lončar et al., 2006;Möller et al., 2017;Oyola et al., 2017) ...
INTRODUÇÃO: O neuroenvelhecimento desencadeia alterações importantes no sistema sensorial. Dentre elas, ocorre declínio na acuidade visual, audição, olfato, paladar e na sensibilidade vibrotátil. Isso afeta a qualidade de vida dos idosos influenciando nas atividades de vida diárias (AVDs), ielevando o risco de quedas e fraturas, detecção de perigo, status nutricional e sociabilidade. OBJETIVOS: Avaliar evidências bibliográficas sobre as alterações sensoriais e seus impactos no neuroenvelhecimento fisiológico. METODOLOGIA: Revisão narrativa realizada na base de dados PubMed, utilizando os descritores “aged”, “sensory impairment” e “ocular physiological phenomena” associados mediante operador booleano AND. Foram incluídos trabalhos realizados em idosos, que foram publicados nos últimos 5 anos e de acesso gratuito completo, totalizando 20 artigos, dos quais 14 foram excluídos por fuga ao tema, resultando em 6 selecionados. RESULTADOS: Os resultados demonstraram que as funções sensoriais podem servir como biomarcadores funcionais não invasivos para descrever o declínio e prejuízo cognitivo. Dentre as deficiências sensoriais, as que apresentaram maior impacto no prejuízo cognitivo são as auditivas, visuais e olfativas. É sugerido que a deterioração cognitiva estaria associada à privação visual na velhice mediante os fatores da acuidade visual e do uso de óculos para leitura. Quanto aos fatores sociais, relacionaram-se a dificuldade de comunicação, isolamento social, deficiências auditivas e visuais. CONCLUSÃO: Evidencia-se, que o envelhecimento está ligado a dois processos: o comprometimento sensorial e o declínio cognitivo. Ao primeiro item, alguns achados apontaram a teoria do fator específico como fator preditor, prevendo que a deterioração de cada sistema se desenvolve de maneira isolada dos demais. Além disso, a visão e a audição foram identificadas como forte preditor de deterioração cognitiva associada à privação sensorial. Entretanto, existem dados limitados sobre a ligação entre os processos citados, especialmente em idosos, sendo necessários mais estudos para esclarecer a correlação.
PALAVRAS-CHAVE: Idoso; Neurologia; Órgãos dos Sentidos.
... Seis estudos (Himmelfarb, Yaeger, & Mintz, 2006;Kang, Dalager, Mahan, & Ishii, 2005 (Himmelfarb, Yaeger, & Mintz, 2006;Lončar, Medved, Jovanović, & Hotujac, 2006;Möller, Söndergaard, & Helström, 2017;Oyola, Guardiola, Carvajal, & Torre, 2017) apresentaram uma amostra totalmente do sexo feminino, enquanto os outros dois (Kang, Dalager, Mahan, & Ishii, 2005;Monteith, Menefee, Forster, & Bahraini, 2016) tiveram uma amostra com ambos os sexos. ...
... Além disso, é possível verificar a nota atribuída para cada estudo incluído, referente à qualidade metodológica. A maioria dos artigos (Himmelfarb et al., 2006;Kang et al., 2005;Möller et al., 2017;Monteith et al., 2016) apresenta um baixo risco de viés, enquanto dois estudos (Lončar et al., 2006;Oyola et al., 2017) foram classificados com alto risco de viés. A tabela 2 representa os diagnósticos reportados pelos artigos incluídos. ...
... A tabela 2 representa os diagnósticos reportados pelos artigos incluídos. Cinco (Himmelfarb et al., 2006;Kang et al., 2005;Lončar et al., 2006;Möller et al., 2017;Oyola et al., 2017) ...
... Seis estudos (Himmelfarb, Yaeger, & Mintz, 2006;Kang, Dalager, Mahan, & Ishii, 2005 (Himmelfarb, Yaeger, & Mintz, 2006;Lončar, Medved, Jovanović, & Hotujac, 2006;Möller, Söndergaard, & Helström, 2017;Oyola, Guardiola, Carvajal, & Torre, 2017) apresentaram uma amostra totalmente do sexo feminino, enquanto os outros dois (Kang, Dalager, Mahan, & Ishii, 2005;Monteith, Menefee, Forster, & Bahraini, 2016) tiveram uma amostra com ambos os sexos. ...
... Além disso, é possível verificar a nota atribuída para cada estudo incluído, referente à qualidade metodológica. A maioria dos artigos (Himmelfarb et al., 2006;Kang et al., 2005;Möller et al., 2017;Monteith et al., 2016) apresenta um baixo risco de viés, enquanto dois estudos (Lončar et al., 2006;Oyola et al., 2017) foram classificados com alto risco de viés. A tabela 2 representa os diagnósticos reportados pelos artigos incluídos. ...
... A tabela 2 representa os diagnósticos reportados pelos artigos incluídos. Cinco (Himmelfarb et al., 2006;Kang et al., 2005;Lončar et al., 2006;Möller et al., 2017;Oyola et al., 2017) ...
... This ratio excludes childhood sexual abuse before the age of 15, which is thought to impact an additional 13-16% of women (AIHW, 2019). Research shows that TI is common during sexual assault, with as many as 70% of the women screened at an emergency rape clinic in Stockholm, Sweden reporting significant TI at the time of the rape (Moller et al., 2017). A biological response of TI experienced during a sexual assault, means that a person may not be able to protest against or defend themselves physically from the perpetrator of rape (Porges & Peper, 2015). ...
... Systematic reviews conducted ten years ago found an experience of sexual assault or sexual abuse to be associated with the subsequent development of significant somatic and mental health disorders (Chen et al., 2010;Paras et al., 2009). More recently, the focus of research has advanced to include emerging studies focusing on TI and the incidence of TI experienced during a sexual assault (Moller et al., 2017). For example, a Brazilian study recently found TI to be nearly twice as prevalent in sexual assault and abuse than in other types of traumatic incidents (Kalef et al., 2017). ...
... These findings provide clear evidence that sexual assault trauma impacts the whole body and continues to impact women long after the assault has ended. Moller et al. (2017) conducted a study on 298 women who attended a rape clinic within a month of being sexually assaulted. These women were asked to complete the TIS. ...
Sexual assault leaves a lasting imprint on the life of a survivor. This impact is commonly reported on in the medical literature as physical and mental health conditions associated with sexual assault trauma. The life-threatening nature of a sexual assault frequently elicits, at the time of the assault, a biological involuntary reflexive response known as tonic immobility. Research into sexual assault has traditionally focused on these two areas, the incidence of tonic immobility and the resultant comorbidities. Clinical intervention research to support and guide practice for therapists who work somatically with women who have been sexually assaulted is limited. This qualitative case study aims to address this by exploring the somatic interventions a therapist uses when treating women presenting with sexual assault trauma involving tonic immo-bility. The findings of this study describe the specific exercises, movements, body awareness training, and breathing and grounding techniques used by a body psychotherapist.
... negative emotions, and feelings that the sufferer's life is in danger [136]) and has been correlated with a greater risk of PTSD [137,138]. At a behavioral level, acute dissociation is characterized by a prolonged absence of response referred to as ''tonic immobilization'' (in animals) or ''involuntary paralysis'' (in humans) [139,140]. Unlike the transient reflex immobility of the first moments (''freezing''), or the voluntary immobilization as a strategy to escape the threat (''attentive immobility''), this type of immobilization, resulting from limbic system deactivation, is lasting and involuntary. In animals, tonic immobility is described as the ultimate defense reaction when prey has no means of escape from their predators. ...
... In animals, tonic immobility is described as the ultimate defense reaction when prey has no means of escape from their predators. Recently, tonic immobility has been associated with the involuntary paralysis reported in rape victims and has been found to be predictive of PTSD development and its clinical severity [138][139][140][141]. This dissociation, by inhibiting the limbic system, which includes the hippocampus, may be responsible for the most severe cases of traumatic amnesia [68,113,114]. ...
... Several studies have shown that dissociative states, whether peri-traumatic or chronic, are correlated with the most severe PTSD symptoms and comorbidities. Comorbidities can be psychiatric, cardiovascular, digestive, metabolic, and/or immune disorders [23,139,141]. ...
Acute stress disorder and post-traumatic stress disorder are generally triggered by an exceptionally intense threat. The consequences of this traumatogenic situation are explored here in chronological order, from exposure to the threat to development of symptoms. Such a situation may disrupt the equilibrium between two fundamental brain circuits, referred to as the "defensive" and "cognitive". The defensive circuit triggers the stress response as well as the formation of implicit memory. The cognitive circuit triggers the voluntary response and the formation of explicit autobiographical memory. During a traumatogenic situation, the defensive circuit could be over-activated while cognitive circuit is under-activated. In the most severe cases, overactivation of the defensive circuit may cause its brutal deactivation, resulting in dissociation. Here, we address the underlying neurobiological mechanisms at every scale: from neurons to behaviors, providing a detailed explanatory model of trauma.
... Although TI is a defensive mechanism intended to protect humans and other animals from physical harm or death, it has been linked with long-term psychological distress, including posttraumatic stress disorder (PTSD), depression, and anxiety (de Kleine et al., 2018;Marx et al., 2008;Möller et al., 2017). TI has been associated not only with PTSD severity (de Kleine et al., 2018;Fiszman et al., 2008;Möller et al., 2017), but also with poorer treatment outcomes (Fiszman et al., 2008;Lima et al., 2010), even after controlling for other peritraumatic responses, such as dissociation and panic (Lima et al., 2010;Rocha-Rego et al., 2009). ...
... Although TI is a defensive mechanism intended to protect humans and other animals from physical harm or death, it has been linked with long-term psychological distress, including posttraumatic stress disorder (PTSD), depression, and anxiety (de Kleine et al., 2018;Marx et al., 2008;Möller et al., 2017). TI has been associated not only with PTSD severity (de Kleine et al., 2018;Fiszman et al., 2008;Möller et al., 2017), but also with poorer treatment outcomes (Fiszman et al., 2008;Lima et al., 2010), even after controlling for other peritraumatic responses, such as dissociation and panic (Lima et al., 2010;Rocha-Rego et al., 2009). ...
Objective:
Tonic immobility (TI) is a peritraumatic response to extreme threats. It is associated with trauma psychopathology and poor treatment outcomes. Yet, previous psychometric evaluations have yielded inconsistent results regarding the number of latent factors of the Tonic Immobility Scale (TIS). Moreover, the TIS has never been validated in a Hebrew-speaking population. This study had two objectives: (a) to reassess previously proposed models of the TIS to determine whether it is best represented by a one-factor model of TI, a two-factor model of TI and fear, or a three-factor model of TI, fear, and detachment; and (b) to validate the TIS in a Hebrew translation.
Method:
A sample of Israeli adults was culled from an online survey following rocket attacks. Confirmatory factor analysis was applied to test the previously proposed models, and Pearson's correlations were used to test the association between each of the subscales representing the latent factors and psychological distress.
Results:
The best representation of the data was provided by a three-factor model with latent constructs of TI, fear, and detachment. All three peritraumatic responses had significant correlations with peritraumatic distress. Moreover, the internal consistency of the TIS was good for the three subscales; this supports the reliability of the Hebrew version.
Conclusion:
This study supports using a three-factor model with latent constructs, and the scale appears to be psychometrically sound when translated into Hebrew. Future research should seek to replicate these findings in different trauma populations and should study the unique association of trauma symptomatology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... An individual may respond to threats and perceived threats by cycling through corresponding somatic survival responses (fight-flight-submit-attach-freeze) in an effort to self-regulate (Seubert and Virdi, 2018;Corrigan et al., 2011). Further, somatic responses during trauma (i.e., tonic immobility, peri-traumatic dissociation) may heighten likelihood of developing PTSD, poorer recovery from PTSD, poorer response to standardised pharmacological PTSD treatments, and increased likelihood of these responses to future trauma, indicating long-term changes to the nervous system after extreme fear and life-threatening experiences (Hagenaars and Hagenaars, 2020;Möller et al., 2017;DeMello et al., 2023;Fiszman et al., 2008). Child abuse and sexual assault is significantly associated with tonic immobility and peri-traumatic association (Möller et al., 2017;Kalaf et al., 2017), and these types of trauma are significantly linked to EDs (Molendijk et al., 2017;Caslini et al., 2016;Convertino et al., 2022), which has important implications for the trauma-ED pathway. ...
... Further, somatic responses during trauma (i.e., tonic immobility, peri-traumatic dissociation) may heighten likelihood of developing PTSD, poorer recovery from PTSD, poorer response to standardised pharmacological PTSD treatments, and increased likelihood of these responses to future trauma, indicating long-term changes to the nervous system after extreme fear and life-threatening experiences (Hagenaars and Hagenaars, 2020;Möller et al., 2017;DeMello et al., 2023;Fiszman et al., 2008). Child abuse and sexual assault is significantly associated with tonic immobility and peri-traumatic association (Möller et al., 2017;Kalaf et al., 2017), and these types of trauma are significantly linked to EDs (Molendijk et al., 2017;Caslini et al., 2016;Convertino et al., 2022), which has important implications for the trauma-ED pathway. When faced with stressful experiences and unable to regulate their nervous system after a threat or perceived threat (i.e., trauma resurgence) has passed, individuals utilise a variety of coping responses (i.e., disordered eating, excessive exercise) to decrease the sense of heightened danger (Seubert and Virdi, 2018;Corrigan et al., 2011;Brewerton, 2022). ...
Anorexia nervosa (AN) is a severe illness with diverse aetiological and maintaining contributors including neurobiological, metabolic, psychological, and social determining factors. In addition to nutritional recovery, multiple psychological and pharmacological therapies and brain-based stimulations have been explored; however, existing treatments have limited efficacy. This paper outlines a neurobiological model of glutamatergic and γ-aminobutyric acid (GABA)-ergic dysfunction, exacerbated by chronic gut microbiome dysbiosis and zinc depletion at a brain and gut level. The gut microbiome is established early in development, and early exposure to stress and adversity contribute to gut microbial disturbance in AN, early dysregulation to glutamatergic and GABAergic networks, interoceptive impairment, and inhibited caloric harvest from food (e.g., zinc malabsorption, competition for zinc ions between gut bacteria and host). Zinc is a key part of glutamatergic and GABAergic networks, and also affects leptin and gut microbial function; systems dysregulated in AN. Low doses of ketamine in conjunction with zinc, could provide an efficacious combination to act on NMDA receptors and normalise glutamatergic, GABAergic and gut function in AN.
... Focusing primarily on actions that deescalate sexual assault misses other potentially common behaviors. For example, disassociation is a common behavior during sexual assault (Campbell, 2012;Möller et al., 2017;Van der Kolk, 2015). This behavior serves to protect the victim as an emotional coping mechanism but does not deescalate the assault . ...
... Again, these findings are similar to Edward et al. (2014) findings. It is well documented that traumatic responses, such as sexual assault, can create a flight response in the autonomic nervous system causing a person to freeze and dissociate (Campbell, 2012;Möller et al., 2017;Van der Kolk, 2015). As such, the emergence of the sub-code Frozen / Shock, is not in fact shocking. ...
IntroductionHow sexual assault victims conceptualize their experiences are shaped, in part, by adherence to rape myths and victim blaming. Victim blaming is predicated on the idea that victims should have done something differently to prevent sexual assault from happening. To better understand victims’ experiences, we documented victim reactions during sexual assault and how victims label and judge the severity of their experience.Methods
We inductively coded 906 US women’s open-ended descriptions of sexual assault from a 2016 cross-sectional online survey. Participants were diverse sexual orientations, incomes, and ages but were not racially diverse (78% white).ResultsWe identified three main themes: Labeling, Judging Severity, and Victim Reactions. Labeling refers to how victims describe their experience—as sexual assault or some other descriptor. Judging Severity captures victims’ perceptions of the experience, for example as severe or relative other experiences. Victim Reactions refers to how victims responded during the assault.Conclusions
Normalizing variation in victims’ reactions is important especially given that some state statutes define sexual assault in terms of what a “reasonable person” would recognize as a refusal cue. We find that some victims’ perceptions of their experience change over time. When judging severity, women mentioned two ends of a continuum (i.e., worst experience of my life vs. not a big deal); both are valid. But, participants’ perceptions that sexual assault is a “normal experience” is concerning.Policy ImplicationsOur findings could inform sexual violence prevention programs, norming campaigns, statute of limitations policies, and criminal justice services.
... However, as both involve different mechanisms regarding memory and alertness, it has been proposed that the two responses may differ in their underlying physiology and occur in different stages of the human defense cascade (Bovin, Ratchford, et al., 2014;Schauer & Elbert, 2010). Both TI and PTD have been identified as risk factors for the development of depression and anxiety symptoms (Bronner et al., 2009;Heidt et al., 2005;Möller et al., 2017;Rizvi et al., 2008), as well as significant predictors of the development and severity of posttraumatic stress disorder (PTSD) (Aho et al., 2017;Bovin, Ratchford, et al., 2014;De Soir et al., 2015;Gandubert et al., 2016;Peltonen et al., 2017;Werner & Griffin, 2012). ...
... Our initial hypotheses were partially refuted since there was no association between TI occurrence and more severe PTSD. This contrasts with the current body of evidence implicating TI in the severity of PTSD (de Kleine et al., 2018;Hagenaars, 2006;Hagenaars & Hagenaars, 2020;Lima et al., 2010;Möller et al., 2017), though it is consistent with two previous studies (Abrams et al., 2012;Van Buren & Weierich, 2015). It is necessary to highlight that our study has a small sample of participants who completed the TIS, which likely impacted our findings. ...
Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence ( R ² = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster ( p = .058). PTD was strongly correlated with anxiety ( R ² = .619; p < .001) and depressive symptoms ( R ² = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [ OR]: 1.386; p = .011) and sexual abuse ( OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study ( OR: 0.216; p = .016) and lower income ( OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.
... Studies from other groups have also described the implications of tonic immobility on mental health, showing that the tonic immobility response is a factor that increases individuals' vulnerability to PTSD development (Bovin et al., 2008;Heidt et al., 2005;Humphreys et al., 2010) and could impair PTSD recovery (Hagenaars & Hagenaars, 2020). In the same vein, Möller et al. (2017) showed that the occurrence of tonic immobility seems to increase the risk of PTSD prevalence after sexual assault by 2.75 times. Taken together, these results reveal that tonic immobility in the pandemic context seemed to be as harmful as other traumatic situations more commonly associated with this response, representing an important risk factor for PTSD in healthcare professionals. ...
... Adequate provision of PPE and appropriate professional training are examples of actions that might reduce risk perception in these professionals. Additionally, tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced to reduce the feelings of guilt and shame that might accompany this defensive reaction (Möller et al., 2017). Finally, psychological and psychiatric treatment should continue to be offered to healthcare professionals with intense workloads . ...
The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.
... Officers should also be educated about the concept of tonic immobility. Though many are familiar with natural responses to "fight" or "flee" dangerous encounters, tonic immobility is a natural "freeze" response to danger that can prevent victims' from physically or verbally resisting an attack (Marx, Forsyth, Gallup, Fuse, & Lexington, 2008;Moller, Sondergaard, & Helstrom, 2017). This is particularly important as recent research found that 70% percent of sexual assault victims described experiencing some form of tonic immobility during their attack (Moller et al., 2017). ...
... Though many are familiar with natural responses to "fight" or "flee" dangerous encounters, tonic immobility is a natural "freeze" response to danger that can prevent victims' from physically or verbally resisting an attack (Marx, Forsyth, Gallup, Fuse, & Lexington, 2008;Moller, Sondergaard, & Helstrom, 2017). This is particularly important as recent research found that 70% percent of sexual assault victims described experiencing some form of tonic immobility during their attack (Moller et al., 2017). ...
Purpose
Using data collected from a sample of cases associated with untested sexual assault kits (SAKs), we used focal concerns theory – a framework that identifies themes relevant to criminal justice practitioners' decision-making processes – to assess the correlates of suspect identification and officers' pre-arrest decision to present a case to prosecutors.
Methods
We estimated two logistic regression models. The first model examined the ability of investigators to identify a suspect in the full sample (N = 444). The second model examined officers' decision to present cases to the prosecutor in a subsample of cases in which a suspect was identified (N = 293).
Results
The odds of suspect identification increased when victims cooperated with investigators and witnesses were available, and decreased in stranger cases and when victim credibility concerns were present in police reports. Cases were more likely to be presented to a prosecutor when victims cooperated with police, witnesses were available, suspects confessed to the crime, and suspects had a history of arrest.
Conclusions
Researchers should continue to examine pre-arrest investigative actions to inform policy and training aimed at enhancing victim engagement and reducing case attrition. Additionally, SAKs should be tested to aid investigators in identifying suspects in stranger cases.
... Not surprisingly, the mysterious and deadly nature of the coronavirus has caused many people to be fearful, particularly during the early stages of the COVID-19 pandemic when relatively little was known about the virus (FiveThirtyEight, 2022). Such fear reactions are commonly reported during terrifying situations, such as in panic attacks and physical and sexual assaults (APA, 2013;Marx et al., 2008;Moller et al., 2017). Two other items of the CAS, which measure sleep disturbances (item #2) and appetite loss (item #4) following exposure to coronavirus-related stimuli or thoughts, appear to measure the physical effects of clinical anxiety (APA, 2013). ...
... This might be explained by the effect of PD on dysfunctional trauma memories 25 and self-related cognitions, 36 as well as the elevated guilt that has been found in relation to TI. 28 Research has indeed indicated that both predict subsequent PTSD 18,28,37 and posttraumatic distress manifested in depression, anxiety, and chronic dissociation. 11,34,[37][38][39] Furthermore, the trauma literature implies that both may serve as mechanisms at the basis of the relationship between perceived threat and PTSD. 18,29 According to this view, elevated sense of threat during trauma exposure may generate defensive reactions of PD and TI that, in turn, impede reprocessing the trauma and therefore may lead to PTSD. ...
Objective: Tonic immobility (TI) and peritraumatic dissociation (PD) are common peritraumatic reactions associated with psychopathology following trauma. The present study aimed to test whether TI and PD mediated the relationship between perceived threat during an episode of rocket shelling and subsequent posttraumatic stress symptoms. Methods: In a prospective study among 226 Israeli civilians, data were collected both during rocket shelling, between May 14, 2021, until ceasefire on May 21, 2021 (T1) and 1 to 2 months after ceasefire (T2). Measures included the Tonic Immobility Scale, Peritraumatic Dissociative Experiences Questionnaire, and PTSD Checklist for DSM-5. Four mediation models were applied for each posttraumatic stress symptom cluster. Results: Findings showed that a substantial proportion of participants had developed posttraumatic stress disorder (PTSD) symptoms at the time of follow-up (18.8%). Both TI and PD fully mediated the relationship between perceived threat and symptoms of intrusion, avoidance, and negative alterations in mood and cognition, but only PD mediated the relationship with alterations in arousal and reactivity. Conclusions: The present findings suggest that TI and PD may serve as mechanisms underlying the link between individuals' appraisals of threat during the peritraumatic phase and subsequent PTSD symptomatology. Future research should seek to replicate the present findings before any conclusions can be drawn. In particular, the association between PD and arousal and reactivity symptoms should be further explored, given that it might be multifaceted in nature.
... Inconsistencies in a victim's statement when reporting to police have also been common in sexual assault cases (Lonsway, 2010), though this has often been the consequence of trauma rather than deception (R. Campbell, 2012;Franklin et al., 2020). Moreover, up to 70% of sexual assault victims have experienced tonic immobility-a biological "freeze" response to fear or threats of bodily harm (Möller et al., 2017). Tonic immobility safeguards the body by shutting down major systems to preserve well-being, but the resulting cascade of hormones and chemicals that protect the body can also prevent sexual assault survivors from verbally and/or physically resisting an attack because they are unable to move (Galliano et al., 1993;Marx et al., 2008). ...
Objectives
Examine the effect of a 40-h police sexual assault training and individual-level impulsivity on officers’ intention to make an arrest and the importance placed on using procedural justice when interacting with victims.
Methods
Training courses were randomly assigned to the treatment and control groups. Vignettes depicting sexual assault reports were randomly assigned to participants (N=318) in each group. Vignette manipulations were randomized by victim-offender relationship (stranger/non-stranger) and rape myth acceptance (present/not present/ambiguous).
Results
Training increased officers’ intentions to arrest. Training and lower impulsivity increased the importance officers placed on using procedural justice. Vignette manipulations were not significantly correlated with either outcome. Impulsivity did not moderate—or change—training effects.
Conclusions
Sexual assault training can increase officers’ self-reported intentions to arrest and the perceived importance placed on using procedural justice in interactions with victims. This finding is important as prior research demonstrated that using procedural justice principles can improve victim engagement with investigators.
... The most important risk factor linked to post-traumatic stress disorder (PTSD) and many other chronic DSM disorders, according to Möller et al. (2017) is sexual assaults. According to the intensity of the assault, it is believed that 10 to 19% of people on average experience PTSD following sexual assaults occurrence (Tiihonen et al., 2014). ...
Background: Sexual assault among the mentally ill has become a common trend of public health concern occurring in various forms and perpetrated by different classes of individuals. It has become a more accurate predictor of suicidal ideation and attempt than any other form of abuse. Aim: This study determined the prevalence and pattern of sexual assaults among the mentally ill attending the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a descriptive cross-sectional study conducted among attendees of Neuropsychiatric Outpatient Clinic of the University of Port Harcourt Teaching Hospital (UPTH). A structured questionnaire covering socio-demographic characteristics and other factors were self-administered to 75 patients diagnosed with various psychiatric disorders by consultant Psychiatrists at the out-patient clinic via a systematic random sampling method. Ethical approval was obtained from the ethical committee of the University of Port Harcourt Teaching Hospital. Descriptive statistics was used to analyze the data. Results: Majority of the mentally ill patients were male (81%), had tertiary education (58.7%), and between the ages of 21 and 30 (44%). The most common mental illness experienced by victims of sexual assault include depression 21(28.0%), the least being sleep and personality disorders 1(1.3%). 16% reported that they had experienced sexual assault, and majority (38.7%) reported that the assault occurred when they were between the ages of 10 and 18. Majority of perpetrators of sexual assault were siblings 5(6.7%), followed by mother 3(4.0%). Some percentage was strangers (1.3%), with the rest being either a visitor to the house (1.3%), or neighbor (1.3%). Only (2.7%) of those who experienced sexual assault reported the assault, (9.3%) did not report it, while 66 (88%) had no response. Conclusion: Sexual assault among the mentally ill is on the rise and manifests in several forms. Measures should be taken by all stakeholders including the government to curb this ugly trend.
... Not surprisingly, the mysterious and deadly nature of the coronavirus has caused many people to be fearful, particularly during the early stages of the COVID-19 pandemic when relatively little was known about the virus (FiveThirtyEight, 2022). Such fear reactions are commonly reported during terrifying situations, such as in panic attacks and physical and sexual assaults (APA, 2013;Marx et al., 2008;Moller et al., 2017). Two other items of the CAS, which measure sleep disturbances (item #2) and appetite loss (item #4) following exposure to coronavirus-related stimuli or thoughts, appear to measure the physical effects of clinical anxiety (APA, 2013). ...
This chapter provides an overview of the five-item self-report Coronavirus Anxiety Scale (CAS) that was developed for the purpose of quickly and effectively identifying individuals suffering from dysfunctional levels of anxiety associated with the coronavirus. The initial development process and the theoretical foundations of the CAS are presented and followed by an examination of its psychometric properties across independent studies. Translated versions of the CAS are also discussed along with scoring instructions, which may vary for some versions of the instrument. The chapter ends with a discussion of the CAS’s limitations, considerations, recommendations, and concluding comments about this clinical tool.
... This diverges from theoretical expectations, as victim resistance is often seen as a characteristic of "real rape" by practitioners (Estrich, 1987) and a commonly held misconception by police and prosecutors (Franklin, Garza, Goodson, & Bouffard, 2020;Kerstetter, 1990). It follows that "real rape" victims are expected to fight back physically against their attacker, and in reality, many victims experience tonic immobility causing victims to "freeze" and prevent resistance (Moller, Sondergaard, & Helstrom, 2017). ...
... El mecanismo por el cual la víctima se queda aterrorizada y paralizada durante el ataque ha sido estudiado y nombrado como "crisis de la violación" (Temkin et al., 2018) o "inmovilidad tónica", debido a la inhibición motora que provoca el miedo intenso. Möller et al. (2017) estiman que entre el 37% y el 52% de las víctimas manifiestan este tipo de bloqueo. ...
Las agresiones sexuales son un fenómeno social, que tiene como principales víctimas a las mujeres y las niñas. El modo en que los agentes del sistema judicial, como parte de la sociedad, perciben y valoran estos delitos está influido por una serie de mitos y creencias colectivos. Este artículo presenta los resultados de un estudio de caso, que analiza el mito de la violación real a partir de las sentencias penales de la Audiencia Provincial de Madrid dictadas por delitos de agresión sexual entre 2016 y 2018. A partir de un análisis de contenido con enfoque cuantitativo, se examina en qué medida las características de los hechos juzgados coinciden con las del mito, y cómo éste puede influir en el fallo. Las conclusiones muestran que, aunque el patrón que describe el mito de la violación real no se cumple, sin embargo, algunas de sus características siguen influyendo en las decisiones judiciales.
... In this definition, force and violence are crucial aspects for criminal prosecution. However, research has shown that 70% of victims experience tonic immobility: a temporary state of motor inhibition (Möller et al., 2017). This 'tonic immobility' eliminates the need for force and violence. ...
Background: The professional approach of sexual assault victims has changed since the 1970s: from a fragmented model to a centralised ‘gate management model’, where multiple disciplines offer collaborative services at one central location. Like other countries across the globe, the Netherlands took steps towards an integrated, multi-agency support framework for victims of sexual assault.
Objective: The objective of this paper was threefold: (1) to describe the development of the multidisciplinary Sexual Assault Centres (SAC) in the Netherlands, (2) to assess the characteristics of victims who attended the SAC, and the services they used (3) to analyse Strengths, Weaknesses, Opportunities, and Threats of the current framework (SWOT).
Method: The development of the national network of SAC was described. Data on victims presenting at the SACs were routinely collected between 1st January 2016 and 31st December 2020. This data from the sixteen sites was combined and analysed. Also, a SWOT analysis of the SAC was performed.
Results: The SAC was established between 2012 and 2018. From 2016 through 2020 almost 16,000 victims of sexual assault contacted one of the 16 SACs. The data show a steady increase in yearly cases, with a consistently high use of medical and psychological services. The SAC has several strengths, such as its accessibility, and opportunities, such as increasing media attention, that underline its quality and relevance. However, the SAC's inability to reach certain minority groups and the current financial structure are its main weakness and threat.
Conclusions: Despite the growing number of victims attending the SAC and the increasing awareness of the benefits of an immediate multidisciplinary response to sexual assault, there are still deficiencies in the SAC. The SAC continues to work on these deficiencies in order to optimise efficient and effective care for all victims of sexual assault.
... Victim resistance relates to expressions of consent or refusal of sexual activity and, in particular, the form of verbal or non-verbal expression (Wignall et al., 2020). The absence of resistance has sometimes been associated with consent, but other studies have shown that this behavior, in the form of tonic immobility, is an involuntary and temporary state of motor inhibition, characteristic of sexual violence (Möller et al., 2017). ...
Several studies have examined victim blaming in rape scenarios. However, there is limited research on the analysis of the perception of blame when two or more perpetrators are involved. The present article explores the perception of blame in cases involving rape based on the level of resistance shown by the victim and the presence of one or more perpetrators. A study was carried out involving 351 university students who responded to a survey after reading a hypothetical assault scenario. Six situations were established where the victim showed either low or high resistance, depending on whether the resistance was verbal or physical and verbal, and in the presence of one or two male perpetrators. It is expected that perpetrators are more culpable when acting in groups and that less resistance from the victim leads to greater attribution of blame. The results confirm that more blame is attributed to the perpetrators when they act in groups than when they act alone. Likewise, women consider the victim generally exerts greater resistance and this variable influences the attribution of greater blame.
... Indeed, in many instances, victims of rape, regardless of gender/sexual identity, do attempt to resist their assailants (Tark & Kleck, 2014;Weiss, 2010;Wong & Balemba, 2016) for a variety of reasons. Victims' resistance, or lack thereof, is influenced by many factors, including concerns about death or serious injury, substance use, being in a relationship with the assailant and wishing to avoid the escalation of violence within that relationship, and experiences of tonic immobility (Brecklin & Ullman, 2010;Chopin & Beauregard, 2022;Coxell & King, 2010;Harrell, 2012;Kalaf et al., 2017;Messinger, 2017;Moller et al., 2017;Moor et al., 2013;Weiss, 2010). DiMarco et al. are correct to identify that victims of all social identities may not resist their assailants, but such a fact should not serve as a prerequisite to defining a rape occurrence. ...
Our commentary responds to claims made by DiMarco and colleagues in an article published in this journal that the majority of victims of rape are men and that 80% of those who rape men are women. Although we strongly believe that studying male sexual victimization is a highly important research and policy endeavour, we have concerns with the approach taken by DiMarco and colleagues to discuss these incidents. Specifically, we critique their paper by addressing the definitions of rape used by the authors, questioning their interpretation of national victim surveys, evaluating their analysis of the underreporting of male rape, and highlighting the heteronorma-tive framework they use to outline the landscape of male sexual victimization. With this commentary, we call for a holistic, nuanced, and balanced study of male sexual victimization that recognizes the reality of both female-on-male and male-on-male violence, the experiences of survivors, and multi-layered barriers that male victims often encounter.
... Adapun kebiasaan berbicara tidak baik dan bullying atau cyber bullying termasuk dalam kategori kekerasan seksual yang merupakan perbuatan merendahkan, menghina, melecehkan, dan/atau menyerang tubuh, dan/atau fungsi reproduksi seseorang yang berakibat pada penderitaan psikis dan/atau fisik (Pasal 1 Permendikbud Ristek 30/2021). Möller et al. (2017) juga menyebutkan bahwa kekerasan seksual maupun kekerasan lain terhadap anak maupun orang dewasa dapat menyebabkan masalah kesehatan hingga menimbulkan depresi. ...
Dalam rangka melaksanakan Peraturan Menteri Pendidikan, Kebudayaan, Riset, dan Teknologi (Kemendikbudristek) Nomor 30 Tahun 2021 tentang Pencegahan dan Penanganan Kekerasan Seksual (PPKS) di lingkungan Perguruan Tinggi, kami melaksanakan kegiatan pengabdian kepada masyarakat dengan program Supporting Pencegahan Kekerasan Seksual di Kelurahan Cakung Timur-Jakarta Timur. Adapun kegiatan yang kami lakukan adalah sosialisasi dalam rangka peningkatan kesadaran masyarakat akan pentingnya pencegahan kekerasan seksual secara verbal maupun non-verbal, pembuatan dan penempelan poster dan webinar pencegahan kekerasan seksual. Metode pelaksanaan secara hybrid yakni online dan offline untuk menjaga protokol kesehatan selama pandemic Covid-19. Secara umum, hasil dari kegiatan kami adalah peningkatan pemahaman masyarakat akan kekerasan seksual dan cara pencegahan. Adapun kuesioner yang kami sebar mendapatkan respon yang positif dari masyarakat karena kegiatan ini memberikan manfaat.
... This evidence suggests that tonic immobility impairs recovery from PTSD. Additionally, Möller et al, 57 showed that the occurrence of tonic immobility seems to increase the risk of PTSD prevalence after sexual assault. Interestingly, the prevalence of PTSD in women who experienced extreme tonic immobility during assault was almost twice as high as that in women who did not experience tonic immobility, corroborating the idea that this response contributes to psychopathological outcomes, particularly PTSD symptoms; please see the work of Abrams et al, 9 for an exception. ...
Purpose:
Growing evidence suggests that peritraumatic tonic immobility, an involuntary defensive response that involves extreme physical immobility and the perceived inability to escape, is a significant predictor of post-traumatic stress disorder (PTSD) symptomatology. However, this issue has not been specifically addressed in adolescents. Here, we investigated whether tonic immobility response experienced during the worst childhood or adolescent trauma is associated with PTSD symptom severity in a non-clinical student sample.
Methods:
The sample was composed of students in 9th grade who were attending public and private schools. Symptoms of post-traumatic stress and tonic immobility were assessed using questionnaires. We performed bivariate and multivariate negative binomial regressions to examine whether tonic immobility was associated with PTSD symptomatology after controlling for confounders (peritraumatic dissociation, peritraumatic panic reactions, gender, age and time since trauma).
Results:
We found an association between tonic immobility and PTSD symptom severity, even after controlling for confounders. Therefore, tonic immobility is associated with PTSD symptoms in trauma-exposed adolescents.
Conclusion:
These findings highlight tonic immobility as a possible risk factor that could be used to provide direction for more targeted trauma interventions for individuals, particularly those at risk for developing PTSD. Therefore, it contributes to preventing and reducing the psychiatric burden in adolescence and later in life.
... Research has also found that up to 70% of sexual assault survivors reported evidence of tonic immobility. While many officers and members of the general public may be familiar with natural responses to either "fight" or "flee" when facing danger, tonic immobility refers to a natural "freeze" response that hinders victims' ability to physically or verbally resist an assailant (Moller et al., 2017). In addition, victims who experience tonic immobility may not sustain visible injury due to biological responses (e.g., lowered blood pressure) that occur naturally to minimize physical harm (Marx et al., 2008). ...
Few studies have evaluated the effectiveness of sexual assault investigations training using experimental designs. Existing studies have not examined the impact of officers’ levels of impulsivity and education on training effectiveness. Using a Solomon four-group quasi-experimental design to assess pretesting effects, we examined the impact of training, impulsivity, and education on officers’ ( N = 432) adherence to rape myths and knowledge of victim reporting behaviors. Ordinary least squares (OLS) models were estimated to examine main effects of training, and moderating effects of impulsivity and education on training for our outcome variables. Results demonstrated that training, impulsivity, and education predicted improvements in attitudinal and cognitive outcomes. However, neither impulsivity nor education moderated—or changed—the effectiveness of training. In addition, training effects held over time, and we did not detect evidence of pretesting effects. Findings from this study improve our understanding of police sexual assault investigations training and provide methodological advancements for police training evaluations.
... They recalled not being able to move even if they wanted to fight the perpetrator or escape the unfortunate event. According to Möller, Söndergaard, and Helström (2017), tonic immobility is a temporary state of involuntary motor inhibition in response to an overwhelming fearful situation. This type of reaction is usually observed in victims of sexual violence in which they were unable to think, act or react in those kinds of situations (Lonsway Archambault, 2017). ...
Sexual violence is a catastrophic phenomenon that most women encounter worldwide. However, the stigma surrounding the victims of sexual violence often leads to a culture of silence, causing the number of such cases to be underreported, leading to limited sexual violence-related studies. With this, the goal of this study is to contribute additional information on the experiences of Filipino victims with sexual violence, its impacts, and their coping mechanisms. Ten Filipino women, who were victims of sexual violence, were interviewed in this study. Thematic analysis was used to analyze the gathered data. Themes on their experiences, the effects of sexual violence, and their coping mechanisms were formulated and presented in this study. The study showed that the most common type of sexual violence experienced by the participants was rape. They also reported feelings of fear during and after the abuse. Feelings of shame and guilt were also experienced, which kept them silent about their negative experiences. Experiencing sexual violence can have negative impacts on an individual's total well–being. To cope with these adverse experiences, they sought support from their families and friends. Some confronted their problems and even employed positive reappraisal, while some used avoidance coping.
... Considering a prevalence of child sexual abuse of 18.0% (range 11.3-21.5%) among women (Fedina et al., 2018;Stoltenborgh et al., 2011), the risk for PTSD after sexual abuse and the risk for re-victimization and further traumatization after sexual abuse Moller et al., 2017;Papalia et al., 2017), an accessible and cost-effective treatment for PTSD is of great importance. ...
Sexual violence is a global public health problem of epidemic proportions due to
its high prevalence and severe health consequences. Only in Sweden the
estimated incidence of penetrative sexual violence is 45 000 per year, and
penetrative sexual violence is only the tip of an iceberg of sexual violence.
The overarching aim of this thesis was to increase the understanding of
1. The burden of disease and non- emergency health care seeking patterns and
needs after sexual violence.
2. The access to non-emergency health care for victims of sexual violence from a
human rights-based approach (HRBA).
In conclusion, the burden of disease among victims of sexual violence was
several-fold compared to non-victims, and HRBA to health care for victims of
sexual violence in Sweden does not exist.
Although everyone can be exposed to sexual violence, the vast majority of
victims are girls and women. The low access to good quality healthcare for
victims of sexual violence means that there is no basic precondition for genderequal
health care in Sweden. Specialist clinics and treatment methods adapted to
the needs of victims of sexual abuse are two key factors for change.
A gatekeeping model is proposed as a tool for identification of key factors
impacting health care access for victims of sexual violence. In accordance with
HRBA to health, it is suggested to be used not only for promotion of good
quality health care access, but also to facilitate the process of accountability and
to enable victims of sexual violence to claim their rights.
A new treatment method of PTSD after rape is also presented in the thesis.
... First, in the instance of rape, the victim often does not perform the same movements as a person who is engaging in consensual sexual intercourse. Victims may struggle, or may be unresponsive because they have been drugged, or may find themselves unable to act due to tonic immobility, which is a common kind of physiological response to danger (Möller et al., 2017). Even if the victim's body is moved around in certain ways by the perpetrator, the victim cannot be said to be making those movements. ...
The notion that rape is an act of violence rather than sex is a central tenet in rape crisis support and education. A therapeutic benefit of this conceptualisation of rape is that it counters shame and guilt by affirming that the victim was not a complicit partner in an act of sex. However, this conceptualisation has recently been criticised for not capturing what makes rape an especially serious kind of wrong. This raises an apparent dilemma for rape crisis support. Recent work in analytic moral philosophy on the nature of rape offers a way to resolve this dilemma. It is argued that rape is not sex, but is nonetheless sexual. This distinction allows for a charitable reformulation of the central tenet in rape crisis support, which can facilitate the dual therapeutic aims of countering the sense of shame and of recognising the especially serious kind of the harm suffered by the victim.
... Even men who were detained may feel that they weren't 'man enough' and should have resisted. Not resisting, however, is a common, normal and sometimes life-saving response; trauma can also sometimes cause tonic immobility (an involuntary, temporary paralysis) in people of all genders (Möller et al., 2017). ...
Sexual violence against men and boys in conflict and displacement has garnered increasing attention over the past decade and has been recognised in UN Security Resolution 2467. Despite increased evidence and understanding of the issue, myths and misconceptions nevertheless abound. The authors of this article – practitioners and academics with extensive experience in the field – aim to dispel ten of the most common misconceptions that we have encountered, and to highlight the current evidence base regarding sexual violence against men and boys in humanitarian settings. We argue that just as there is no universal experience of sexual violence for women and girls, there is no universal experience for men and boys, or for nonbinary people. In order to address the complexities of these experiences, a survivor-centred, intersectional approach is needed.
Open Access Article available at https://www.manchesteropenhive.com/view/journals/jha/2/3/article-p25.xml?fbclid=IwAR3ikY0P7F7TmDv-VypYa-vrMdNyV_uZK4EZwIzzt00AQU4Lv13ANiyhPi4
We extend Conway's self-memory system by adding theory and data from shame, an emotion that disrupts the internalised ideals of society needed for a positive self-concept. The event that caused 273 undergraduates their greatest amount of shame was analyzed; 66% were not very negative except for producing shame. Ratings of post-event effects, including two measure of self (self-perceived weakness, and centrality to identity) and four clinical symptoms (intrusions, avoidance, anxiety, and depression), were attributed separately to the remembered event, behaviour during the event, and shame from the event. The effects of shame were generally as large as the those of the event and larger than those of the behaviour, demonstrating the importance of shame's effects. The Tonic Immobility Scale (TIS), which measures tonic immobility (i.e., freezing), was obtained for the event that produced the most tonic immobility but that was not the event that caused the most shame. The post-event symptoms measured on the event that caused the most shame and the TIS correlated highly, suggesting that shame and tonic immobility may belong to a cluster of phylogenetically conserved submissive defensive mechanisms that could account for effects currently attributed to goals in self-memory systems.
Interactions with police are vitally important to victims' ability to process their trauma. This study focused on the experiences of victims who reported a rape to police in Sweden. Thirteen women participated in interviews; the material was analyzed using inductive thematic analysis. Findings include lack of information and the role of luck in finding an understanding officer; some found comfort, and some felt violated once again. Long processing times bound participants to their trauma. Findings highlight the need for improved knowledge of trauma among police, victims' needs for information and rights to support, and structural barriers that need to be addressed.
There is widespread scientific evidence that validates tonic immobility (TI) as part of the trauma response in victims of rape, and criminal justice practitioners are increasingly trained in trauma-informed approaches. Yet, legal and policy definitions of consent do not fully recognize TI during the incident as evidence of nonconsent. Using a systematic review of U.S. law and policy regarding sexual violence and consent, this paper analyzes the substantial legal reform of rape law and definitions of consent, suggesting ways to further integrate TI into existing law and legal practices to improve public health approaches and justice responses for victims.
Tonic immobility (TI) is a phylogenetically conserved, passive, obligatory defense mechanism commonly engaged during sexual and physical assaults. During TI, people become immobile while remaining conscious and later reexperience intrusive memories of both their assault and of its accompanying immobility. Here we show that this well-studied biological process has powerful effects on memory and other processes. Participants had experienced either a serious sexual (n = 234) or physical (n = 137) assault. For both the assault and its accompanying immobility, the standard measure of the peritraumatic severity of TI correlated between .40 and .65 with post-assault effects on memory, including memory of the assault and memory of the immobility, the two memory-based self-concept measures of self-blame and event centrality, and post-assault anxiety and depression. The correlations with TI were much higher than other peritraumatic characteristics commonly used to predict and describe posttraumatic effects in assaults and other traumas. The results suggest that TI should be considered for a broader, more biologically based and ecologically valid understanding of the effects of trauma on memory and memory-based reactions.
The aim of the current study was to examine the psychological responses of victims during sexual assault, focusing on tonic immobility (TI). TI is characterized by immobility in situations involving the threat of death or a threat to one’s physical integrity. In the current study, 143 sexual assault victims consented to participate in the survey and completed the questionnaires. An exploratory categorical factor analysis revealed that the psychological responses of victims during sexual assaults comprised two factors: TI and fear. Results of structural equation modeling indicated that victims’ fear during the sexual assault increased their TI responses. Furthermore, the high variation of violence, which was influenced by prior relationships between victims and offenders, increased fear and TI responses.
In 2017, Netflix’s 13 Reasons Why received great pushback for its graphic depiction of Hannah Baker’s suicide. Based on Jay Asher’s novel of the same name, the Netflix series ran for four seasons before ending in Summer 2020. But while much discussion has centered around Hannah’s suicide scene and concerns for audience well-being, the series’ long-running dialogue and inclusion of sexual assault has been overlooked. To address this issue, this research applies critical textual analysis and a feminist lens to all four seasons of 13 Reasons Why, arguing that the series opens a space for dialogue related to “who” victims of sexual assault are, how systems fail sexual assault survivors, and that stories of sexual assault do not all end in death.
Background
Tonic Immobility (TI) is a peri-traumatic response that appear to play a vital role in the development of posttraumatic stress disorder (PTSD). TI is characterized by a strong motoric inhibition, a paralysis of movement, thought, emotion, and vocalization, and has primarily been studied in association with rape and childhood sexual assault.
Aim
The present study examines the role of TI in developing ICD-11 PTSD and disturbances in self-organization (DSO) following different types of intimate partner violence (IPV), i.e., physical, sexual, and psychological violence, in a clinical sample of N = 150 women.
Methods
A measurement model for ICD-11 PTSD and disturbances in self-organization (DSO) was constructed using confirmatory factor analysis and three models were computed to test whether the different subtypes of IPV were directly related to symptom severity, or whether they were partly or fully mediated by TI.
Results
Controlling for other types of violence, psychological violence was the only type of violence directly and indirectly related to ICD-11 PTSD and DSO. While most of the relationship consisted of a direct effect, TI acted as a partial mediator of the relationship between psychological violence and PTSD and DSO.
Discussion
Results are discussed regarding our understanding of trauma and how psychologically threatening events can elicit a peri-traumatic response of TI, which has previously been associated primarily with threats to life or physical integrity.
Background
In 2018, Trèbes, 6,000 inhabitants with nine general practitioners (GPs) in southern France, experienced two tragedies; a terrorist attack in March, in which four people were killed, and a catastrophic flood in October, in which six people died and thousands more were affected.
Objectives
We aimed to obtain a substantive theory for improving crisis management by understanding the personal and professional effects of the two successive disasters on GPs in the same village.
Methods
This qualitative study conducted complete interviews with eight GPs individually, with subsequent analyses involving the conceptualisation of categories based on grounded theory.
Results
The analysis revealed that GPs underwent a double status transition. First, doctors who experienced the same emotional shock as the population became victims; their usual professional relationship changed from empathy to sympathy. The helplessness they felt was amplified by the lack of demand from the state to participate in the first emergency measures; consequently, they lost their professional status. In a second phase, GPs regained their values and skills and acquired new ones, thus regaining their status as competent professionals. In this context, the participants proposed integrating a coordinated crisis management system and the systematic development of peer support.
Conclusion
We obtained valuable information on the stages of trauma experienced by GPs, allowing a better understanding of the effects on personal/professional status. Thus, the inclusion of GPs in adaptive crisis management plans would limit the effects of traumatic dissociation while increasing their professional effectiveness.
In this conclusive chapter, we review findings giving support to the hypothesis that TI represents an adaptive, survival response to threatening situations. In models of prey-predator interactions, in vertebrates and invertebrates, there are evidence that immobility per se contributes to survival, as the predator loses interest for a prey in which TI is experimentally induced. TI duration is also reciprocally modulated by the evaluation of the risk factors in the environment, and by the opportunity to reach a safe refuge. This supports the adaptive value of TI and suggests that, during TI, the animal may be transiently aware of the environmental situation. As for the adaptive value of TI, genetic correlations with other behavioral systems contributing to fitness (e.g., mating) are taken into account. Moreover, neurophysiological and endocrine findings in mammals support our hypothesis that TI activates the mechanisms responsible for recovery from disruptive experiences and body lesions.
Sexual violence is a widespread phenomenon, as it has been estimated that about 35.6% of women have experienced some forms of sexual abuse, with variable prevalence estimates worldwide. Sexual violence has remarkable negative consequences on women's health and quality of life, with a specific harmful impact on women's psychological well-being and sexuality. In this narrative review, we provide an overview on the phenomenon of sexual violence against adult women and adolescents, discussing its associated multiple negative consequences with a specific focus on clinical and sexological aspects. ''Women centered care'' and a multidisciplinary approach appear of pivotal importance when working with sexual violence survivors. Woman should be engaged in all the clinical activities as equal partners in the decision-making process, and should be supported by multiple and different professional figures (i.e. gynecologists, psychologists, sexologists, forensic medical doctors, lawyers) working within the framework of a cooperative integrated model.
Many animals react to threatening stimuli such as a predator attacks by freezing. However, little experimental research investigated freeze response in humans. Here, we have employed practices commonly used in self-defence training to create two unique scenarios simulating armed physical attacks. Sixty healthy men volunteers divided into three groups of twenty (untrained, trained but unexperienced, trained and experienced) underwent these scenarios accompanied by measurement of biochemical, physiological, and psychological markers of stress. All participants also underwent an fMRI session during which they observed neutral and negative images from the International Affective Picture System (IAPS). Our results show that scenarios simulating physical attacks can induce a freeze-like response in men. In addition, we demonstrate that while electrodermal activity (EDA), subjective stress perception, and brain activity in fMRI predict freeze-like response in men, their effect on freeze-like response is entirely dependent on the level of training and experience of a given individual.
La violación sexual es un acto que provoca la indignación y el rechazo de la sociedad. El código penal castiga, severamente, al violador pero, frecuentemente, la víctima no denuncia a su agresor por miedo a ser culpabilizada. En este trabajo, se analizan tres casos de violación grupal narrados en la obra Los pasajeros del viento porque su autor, François Bourgeon, trata a las víctimas como sujetos, no como objetos. En cada caso se expone la situación previa a la violación y la causa que la provoca; se describe la escenificación de la violación y se muestra el impacto que sufren las víctimas.
The article concerns the crime of rape stipulated in art. 197 of the Criminal Code, or more precisely the definition of this phenomenon. The author analyzes the regulations penalizing this type of sexual abuse, in force both under Polish criminal law and under international law, in order to find the answer to the question whether the current provisions of the penal code comply with the convention standards and whether the definition of rape corresponds to the theory of sexual autonomy, according to which sex without voluntary, informed, and free of forced consent is rape.
Although catatonia is related to several medical conditions, catatonia as a response to trauma and posttraumatic stress disorder (PTSD) is less clear. The aim of this review is to explore the small emerging body of preliminary evidence that suggests a possible correlation between psychological trauma and catatonia. Initial data suggests a correlation between episodes of intense fear associated with trauma and PTSD and some forms of catatonic responses. Although this relationship is still speculative to be causative, it can have important implications if confirmed. This is especially salient when it is examined alongside existing studies of the response to fear in animals and the phenomenon of tonic immobility, which bears a striking resemblance to catatonia in humans. If prospective studies further support the initial findings, it could change our conceptual understanding of the etiology of a subtype of catatonia substantially while pointing to likely targets of further research to understand the biological mechanisms that underlie the illness.
Rape that does not involve life-threatening physical violence, is committed by someone known to the victim, and is not reported to law enforcement (called, here, commonplace rape) raises two questions: “Why didn't she fight back or run away?” and “Why didn't she say anything at the time?” Recently, research on “tonic immobility,” based on animal predation studies, has provided a physiological explanation for experiences of immobilization during sexual assault. The juxtaposition of animal predation with commonplace sexual assault raises the question: How is it that a response reserved, in animals, for lethal, no-way-out scenarios is present in modes of violation where the victim does not report fear of death or extreme physical harm? Neither does this research help explain why women fail to report. This philosophical exploration of the meaning of tonic immobility in sexual assault helps to justify the juxtaposition of life-or-death scenarios with less-than-life-threatening violation, and sheds light on the reason for women's silence after sexual assault. Rape is accompanied by deep historical meanings that can be encapsulated in the notion of “social death,” associated in the U.S. with colonial conquest, enslavement, and impoverishment. The specter of social death haunts commonplace rape, producing life or death responses.
Objectives
Rape has been found to be the trauma most commonly associated with Posttraumatic Stress Disorder (PTSD) among women. It is therefore important to be able to identify those women at greatest risk of developing PTSD. The aims of the present study were to analyze the PTSD prevalence six months after sexual assaults and identify the major risk factors for developing PTSD.
Methods
Participants were 317 female victims of rape who sought help at the Emergency Clinic for Raped Women at Stockholm South Hospital, Sweden. Baseline assessments of mental health were carried out and followed up after six months.
Results
Thirty-nine percent of the women had developed PTSD at the six month assessment, and 47% suffered from moderate or severe depression. The major risk factors for PTSD were having been sexually assaulted by more than one person, suffering from acute stress disorder (ASD) shortly after the assault, having been exposed to several acts during the assault, having been injured, having co-morbid depression, and having a history of more than two earlier traumas. Further, ASD on its own was found to be a poor predictor of PTSD because of the substantial ceiling effect after sexual assaults.
Conclusions
Development of PTSD is common in the aftermath of sexual assaults. Increased risk of developing PTSD is caused by a combination of victim vulnerability and the extent of the dramatic nature of the current assault. By identifying those women at greatest risk of developing PTSD appropriate therapeutic resources can be directed.
Earlier studies have explored the differences between known-assailant sexual assaults and stranger assaults and reported the stranger assaults as being more violent. Only a few studies have discriminated between sexual assaults by intimate partners from assaults by other known assailants when comparing with assaults by strangers. In this study, we explored differences in the extent of violence and physical injury in sexual assaults committed by intimate partners compared with assaults by strangers and acquaintances. Medical and forensic records of 690 consecutive women attending a sexual assault center in Stockholm, Sweden were reviewed. The final sample included in the analysis consisted of 503 patients. Our results showed that women sexually assaulted by their intimate partners more frequently reported physical violence (OR = 4.1) than women assaulted by strangers (OR = 2.0) and acquaintances (OR = 1.0). Genital injuries were not found to be related to the victim-assailant relationship in this study. Extragenital injuries showed a tendency toward being more frequently found after intimate partner assaults compared with stranger and acquaintance assaults; however, this was not found to be significant in adjusted analyses. Previous history of sexual assault was more common, and seeking medical care within 72 hr as well as being under the influence of alcohol during the assault was less frequent among intimate partner victims. These results support the conclusion that sexual assaults committed by intimate partners, contradictory to earlier studies, are likely to involve more physical violence and result in injuries just as often as assaults committed by strangers.
Tonic immobility is a basic defense strategy which has not been studied in depth in humans. Data suggest that it may be a relatively frequent phenomenon in victims of rape and sexual abuse, but its occurrence has not been systematically explored in other types of trauma. We carried out a retrospective study in a sample of 100 university students to establish whether tonic immobility varies depending on the nature of the worst trauma experienced, defined subjectively by each participant. Immobility was assessed using the Tonic Immobility Scale and traumas were assessed using the modified Traumatic Events Questionnaire. Seventy percent of the sample had experienced trauma of some kind. There were no significant differences in tonic immobility between different types of trauma (e.g., physical abuse, assault or aggression, serious accident), except that the mean tonic immobility score was significantly higher in the group with trauma due to physical/psychological or sexual abuse than in the group with trauma due to receiving news of the mutilation, serious injury, or violent or sudden death of a loved one. We conclude tentatively that tonic immobility may be typical not only of sexual traumas, but of other kinds of directly experienced traumas as well.
This study evaluated whether tonic immobility mediates the relations between perceived inescapability, peritraumatic fear, and posttraumatic stress disorder (PTSD) symptom severity among sexual assault survivors. Female undergraduates (N = 176) completed questionnaires assessing assault history, perceived inescapability, peritraumatic fear, tonic immobility, and PTSD symptoms. Results indicated that tonic immobility fully mediated relations between perceived inescapability and overall PTSD symptom severity, as well as reexperiencing and avoidance/numbing symptom clusters. Tonic immobility also fully mediated the relation between fear and reexperiencing symptoms, and partially mediated relations between fear and overall PTSD symptom severity, and avoidance/numbing symptoms. Results suggest that tonic immobility could be one path through which trauma survivors develop PTSD symptoms. Further study of tonic immobility may inform our ability to treat trauma victims.
When confronted with a sexual attacker, women are often extremely concerned with avoiding rape completion. While narrative reviews typically suggest that the victim resistance is linked to rape avoidance, much of the existing literature relies on overlapping samples from the National Crime Victimization Survey. The current meta-analysis examines whether victim resistance is related to a greater likelihood of avoiding rape completion. Results from a systematic literature search across 25 databases supplemented by a search of the gray literature resulted in 4,581 hits of which seven studies met eligibility criteria for the review. Findings suggest that women who resist their attacker are significantly more likely than nonresisters to avoid rape completion. This finding held across analyses for physical resistance, verbal resistance, or resistance of any kind. Limitations of the analysis and policy implications are discussed, with particular focus on other research findings that resistance may be linked to greater victim injury.
A reliable and valid measure is needed for assessing the psychological symptoms experienced in the aftermath of a traumatic event. Previous research suggests that trauma victims typically experience dissociative, anxiety and other symptoms, during or shortly after a traumatic event. Although some of these symptoms may protect the trauma victim from pain, they may also lead to acute stress, posttraumatic stress, or other disorders. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was developed to evaluate anxiety and dissociation symptoms in the aftermath of traumatic events, following DSM-IV criteria for acute stress disorder. We present data from multiple datasets and analyses supporting the reliability and construct, convergent, discriminant, and predictive validity of the SASRQ.
Tonic immobility (TI) is an involuntary freezing response that can occur during a traumatic event. TI has been identified as a risk factor for posttraumatic stress disorder (PTSD), although the mechanism for this relationship remains unclear. This study evaluated a particular possible mechanism for the relationship between TI and PTSD symptoms: posttraumatic guilt. To examine this possibility, we assessed 63 female trauma survivors for TI, posttraumatic guilt, and PTSD symptom severity. As expected, the role of guilt in the association between TI and PTSD symptom severity was consistent with mediation (B = 0.35; p < .05). Thus, guilt may be an important mechanism by which trauma survivors who experience TI later develop PTSD symptoms. We discuss the clinical implications, including the importance of educating those who experienced TI during their trauma about the involuntary nature of this experience.
Overt signs of victim resistance during rape are critical issues in the handling of and recovery from rape/sexual assault. However, a substantial number of victims do not resist the attacker in any way. Tonic immobility (TI), a well-known involuntary, reflexive response to fear-inducing stimuli, may aid in explaining the paralysis and “freezing” of many rape victims. In the present study, rape survivors were classified as immobile, intermediate, or mobile, based on a self-report measure. The immobile group manifested significantly more of the specific features associated with tonic immobility. Thirty-seven percent of the sample clearly demonstrated immobility during the attack. Various postrape behaviors and attitudes were found to be associated with the incidence of the immobility response.
The present article reports on the development and validation of a self-report measure of posttraumatic stress disorder (PTSD), the Posttraumatic Diagnostic Scale (PTDS), that yields both a PTSD diagnosis according to
Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994
DSM-IV) criteria and a measure of PTSD symptom severity. Two-hundred forty-eight participants who had experienced a wide variety of traumas (e.g., accident, fire, natural disaster, assault, combat) were administered the PTSD module of the Structured Clinical Interview (SCID; Spitzer, Williams, Gibbons, & First, 1990), the PTDS, and scales measuring trauma-related psychopathology. The PTDS demonstrated high internal consistency and test-retest reliability, high diagnostic agreement with SCID, and good sensitivity and specificity. The satisfactory validity of the PTDS was further supported by its high correlations with other measures of trauma-related psychopathology. Therefore, the PTDS appears to be a useful tool for screening and assessing current PTSD in clinical and research settings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article reviews research concerning the possible relationship between tonic immobility (TI) and human reactions to sexual assault. This review includes a description of the characteristic features of TI and a discussion of the most widely accepted theoretical explanation for TI. The possibility that humans may exhibit TI is explored and conditions that might elicit TI in humans are identified. In particular, we focus on TI in the context of sexual assault, because this form of trauma often involves elements that are necessary for the induction of TI in nonhuman animals, namely, fear and perceived physical restraint. The important similarities and differences in how TI manifests in humans and nonhuman animals are highlighted, future research directions are offered, and clinical implications are suggested.
Tonic immobility is the last defense reaction to entrapment by a predator. In humans, peritraumatic tonic immobility was correlated with PTSD severity and poor response to treatment. This study compared the role of peritraumatic dissociation, panic physical symptoms and tonic immobility as predictors of response to standard pharmacotherapy for PTSD. Thirty-six PTSD patients underwent a naturalistic pharmacological treatment. The Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C) and the Clinical Global Impressions Severity of Illness item scores (CGI-S) were employed at baseline and endpoint to examine treatment outcome. Peritraumatic reactions were assessed using the Physical Reactions Subscale, the Peritraumatic Dissociative Experiences Questionnaire and four motor questions of the Tonic Immobility Scale. After controlling for confounders, tonic immobility was the best predictor of a poor response to treatment, either considering the PCL-C or the CGI-S scores. Tonic immobility seems to have a greater negative impact on PTSD prognosis than peritraumatic panic or dissociation. Additional translational and clinical research may inform about particular mechanisms underlying tonic immobility and open new avenues for prevention and treatment of PTSD.
Tonic immobility (TI) is a temporary state of motor inhibition believed to be a response to situations involving extreme fear. Limited attention has been directed to studying TI in humans; however, the phenomenon has been well documented in the animal literature. In humans, TI is believed to occur during sexual assault, and there have been reports of fear-induced freezing in the contexts of air, naval, and other disasters.
This study had three main purposes: (1) to assess the factor structure of a new self-report measure--the Tonic Immobility Questionnaire--designed to assess human TI in a range of traumatic events; (2) to explore associations among discovered TIQ factors and a measure of posttraumatic symptoms in the context of trauma type; and (3) to determine whether TI is related to suspected and empirically supported predictors of posttraumatic stress disorder. Participants were a subset of undergraduate students (n=78) who reported a TI experience in the context of a traumatic event.
No differences were found in frequency or severity of TI reported across trauma types. Exploratory factor analysis of Tonic Immobility Questionnaire item responses resulted in a three-factor solution (i.e., physical immobility, fear, and dissociation). Significant positive correlations were found between the Tonic Immobility Questionnaire and measures of posttraumatic symptoms, dissociation, anxiety sensitivity, and absorption. Regression analysis revealed that peritraumatic dissociation scores alone accounted for 51% of the variance in TI scores.
TI may represent an extreme behavioral expression of trauma-induced peritraumatic dissociation. Implications and directions for future research are discussed.
We sought to determine the association between historical and physical evidence with judicial outcome in sexual assault cases.
A population-based, retrospective review of forensic evidence was conducted for all sexual assault cases reported in Duval County, FL, during a 2-year period. Variables examined included age, race of victim, evidence of trauma (body, genital, or both), presence of spermatozoa at the time of the forensic examination, weapon use, and whether the victim knew the assailant. In cases in which an arrest was made, logistic regression was used to estimate the strength of association with the outcome of conviction in sexual assault cases.
During the study period, 821 sexual assaults were reported, and 801 forensic examinations were performed. The victims were predominantly female (776; 97%), with 409 (51%) being black, 376 (47%) white, and 16 (2%) other minorities. A suspect was identified in 355 (44%) of the 801 cases for which a sexual assault forensic examination was conducted. No suspect was identified in 446 (56%) of these cases. There were 271 arrests made. The police did not have enough evidence to arrest a suspect after detention in 84 cases. For those cases in which a suspect was arrested, 153 had charges dropped, 89 were found guilty, 2 were found not guilty, and 27 cases were still pending or the files were sealed and unavailable for review. There was evidence of trauma in 202 (57%) of the examinations, and spermatozoa were found at the time of the forensic examination in 110 (31%) of the cases in which a suspect was identified. Logistic regression found that victims aged younger than 18 years, the presence of trauma, and the use of a weapon by the assailant were significantly associated with successful prosecution. There was a trend toward conviction if the victim was white.
Emergency physicians have an obligation to provide care for victims of sexual assault cases. This care includes a possible legal defense. To that end, emergency physicians should be vigilant in the documentation of the history of the event (eg, weapon use) and in the documentation of traumatic injuries because these factors can assist in a successful prosecution.
Little is known about lifetime prevalence or age of onset of DSM-IV disorders.
To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older.
Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders.
Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
The present study examined tonic immobility (TI) in victims of childhood sexual abuse (CSA). Female undergraduates (n=39) and female psychiatric inpatients (n=41) who experienced CSA completed a series of questionnaires assessing aspects of their victimization history, psychological functioning, and TI symptoms. Over fifty-two percent of all participants reported TI in response to CSA. Episodes of CSA involving attempted or completed penile/vaginal penetration were more likely to be associated with an increased likelihood of experiencing TI, and report of TI was associated with greater current psychological impairment. The implications of these findings are discussed, and suggestions for future research are offered.
Tonic immobility (TI) is an involuntary component of the fear response that is characterized by freezing or immobility in situations involving extreme fear coupled with physical restraint. The present investigation evaluated the factor structure of the Tonic Immobility Scale (TIS; Forsyth, J. P., Marx, B., Fusé, T. M. K., Heidt, J., & Gallup, G. G., Jr. (2000). The Tonic Immobility Scale. Albany, NY: Authors)--a newly developed measure to assess components of TI in female sexual assault survivors. Study 1 (N=88) consisted of an Exploratory Factor Analysis of sexual assault survivors' responses on the TIS, whereas Study 2 (N=191) involved a Confirmatory Factor Analysis (CFA) with a second independent sample of female sexual assault survivors. Findings from both studies suggest that the TIS is comprised of two independent factors: physical immobility and fear. Findings are discussed in terms of the theoretical and practical implications of the factor solution obtained, particularly with regard to evaluating TI in adult survivors of sexual assault.
The Tonic Immobility Scale
- Forsyth JP
- Marx B
- Fusé TMK
- Heidt J
- Gallup GG Jr
Victim reactions during rape/sexual assault: a preliminary study of the immobility response and its correlates
- Galliano G
- Noble LM
- Travis LA
- Puechl C
The Tonic Immobility Scale
- J P Forsyth
- B Marx
- Fus E Tmk
- J Heidt
- G G Gallup
Forsyth JP, Marx B, Fus e TMK, Heidt J, Gallup GG Jr.
The Tonic Immobility Scale. Albany, NY: Authors, 2000.
Nordic Federation of Societies of Obstetrics and Gynecology
ª 2017 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 96 (2017) 932-938
Victim reactions during rape/sexual assault: a preliminary study of the immobility response and its correlates
- Galliano