Cinsel Saldırı Olgularında Psikolojik İlk Yardım

Öz

Cinsel saldırılar sıklıkla kadınları hedef almakta, diğer şiddet formları ile birlikte görülmekte, mağdurlarda fiziksel yaralanmalara ve psikolojik örselenmeye yol açabilmektedir. Cinsel saldırı mağdurlarının önemli bir kısmı adli bildirim yapmamakta, bildirim yapanlar ise delillerin toplanması için gereken kritik süreyi aşmaktadır. Alanyazında bu durumun cinsel şiddetle ilgili yanlış inanışlar, damgalanma, yakın ilişki içinde rıza dışı cinsel ilişkilerin şiddet olarak algılanmaması ve adli muayenenin travmayı hatırlatıcı etkisi ile ilişkili olduğu belirtilmiştir. Adli bildirim sonrasında hayatını nasıl planlayacağıyla ilgili bilinmezlikler mağdurun yardım arama davranışını etkileyen bir başka faktördür. Bu derlemede cinsel saldırı durumunda psikolojik ilkyardımın amacı, zamanlaması ve müdahalenin aşamaları ele alınmıştır. Psikolojik ilkyardım kısa vadede mağdurun güvenlik ihtiyacı ve olumsuz duygularını ele almayı, yardım almaya hazır hissettiğinde ulaşabileceği kaynakların varlığıyla ilgili bilgilendirmeyi hedeflemektedir. Uzun vadede ise mağdurdaki psikolojik örselenmeyi azaltmaya yardımcı olmaktadır. Müdahale mağdurla ilişkinin kurulması, problemlerin tanımlanması, duyguların ele alınması, alternatiflerin keşfedilmesi, eylem planının geliştirilmesi ve takip aşamalarından oluşmaktadır. Psikolojik ilk yardım sadece sağlık çalışanı- hasta kooperasyonunu sağlayarak delillerin sağlıklı bir şekilde toplanmasını sağlamakla kalmaz aynı zamanda mağdurun güvenlik planının hazırlanmasına ve duygusal örselenmesinin azaltmasına da katkı sağlamaktadır.

Anahtar Kelimeler

• cinsel istismar
• ilkyardım
• kriz müdahalesi
• travma sonrası stres bozukluğu
• tecavüz

Psychological First Aid in Sexual Assault Cases

Abstract

Sexual assaults often targeting women, cooccur with other forms of violence, may cause physical injuries and psychological harm in victims. A significant number of sexual assault victims do not make legal notifications and those who do exceed the critical time required for collecting evidence. According to the literature, this is related to myths about sexual violence, stigmatization, not perceiving non-consensual sexual behavior as violence in intimate relationships, and the trauma reminding effect of forensic examination. Uncertainties about how to plan the life after a legal notification is another factor that affects the victim’s helpseeking behavior. The aim, timing, and stages of psychological first aid addressed in this review. Psychological first aid aims to address the safety needs and negative feelings of the victim and to inform about the availability of resources when they feel ready to seek help in the short term. It helps to reduce the psychological trauma of the victim in the long run. The intervention consists of establishing a relationship with the victim, identifying problems, dealing with feelings, discovering alternatives, developing an Action plan and follow-up. Psychological first aid not only ensures the collecting evidence by providing healthcare worker-victim cooperation but also the preparation of the victim’s safety plan and reduce the emotional trauma.

Keywords

• Sexual violence
• first aid
• crisis intervention
• posttraumatic stress disorders
• rape

Kaynakça

1. Alsaker K, Morken T, Baste V, Campos-Serna J, Moen BE (2012) Sexual assault and other types of violence in intimate partner relationships. Acta Obstet Gynecol Scand, 91:301–307.
2. Arendt M, Elklit A (2001) Effectiveness of psychological debriefing. Acta Psychiatr Scand, 104:423-437.
3. Aşırdizer M (2006) Acil servislere başvuran çocuk ve kadın istismarı olgularına hekimlerin yaklaşımı. Turkiye Klinikleri J Surg Med Sci, 2:39-48.
4. Barutçu N, Yavuz MF, Çetin G (1999) Cinsel saldırı sonrası mağdurun karşılaştığı sorunlar. Bull Leg Med., 4:41-53.
5. Bisson J, Andrew M (2007) Psychological treatment of post‐traumatic stress disorder (PTSD). Cochrane Database Syst Rev, 4:1-61.
6. Bokszczanin A (2008) Parental support, family conflict, and overprotectiveness: Predicting PTSD symptom levels of adolescents 28 months after a natural disaster. Anxiety Stress Coping, 21:325-335.
7. Campbell R, Dworkin E, Cabral G (2009) An ecological model of the impact of sexual assault on women's mental health. Trauma Violence Abuse, 10:225-246.
8. Castillo DT, Chee CL, Nason E, Keller J, C’de Baca J, Qualls C et al. (2016) Group-delivered cognitive/ exposure therapy for PTSD in women veterans: A randomized controlled trial. Psychol Trauma, 8:404-412.

9. Chivers-Wilson KA (2006) Sexual assault and posttraumatic stress disorder: a review of the biological, psychological and sociological factors and treatments. Mcgill J Med, 9:111–118.
10. Coker AL, Smith P H, McKeown RE, King MJ (2000) Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. Am J Public Health, 90:553.
11. Demiralp M, Sarıkoç G (2016) Psikiyatrik acillerden biri: cinsel şiddet ya da saldırı gören birey ve yardım etme. TAF Prev Med Bull, 15:363.
12. Demirer M, Küpeli A, Çaylı E, Gürpınar SS, Baydar ÇL (2013) Cinsel saldırı/istismar olgularında birden fazla kez yapılan ruhsal durum muayene bulgularının değerlendirilmesi. Turkiye Klinikleri J Med Sci, 33:1448-55.
13. Dünya Sağlık Örgütü (2011) Psikolojik İlk Yardım: Saha Çalışanları İçin Rehber. (Çev. Ed. Ö. Erdur-Baker, 2014). Ankara: Türk Psikolojik Danışma ve Rehberlik Derneği. Available from: URL:http://www.pdr.org.tr/userfiles/Psikolojik-ilkyardim.pdf. Accessed date: 01.04.2018.
14. Dworkin ER, Schumacher JA (2018) Preventing Posttraumatic Stress Related to Sexual Assault Through Early Intervention: A Systematic Review. Trauma Violence Abuse, 19:459–472.
15. Elliott DM, Mok DS, Briere J (2004) Adult sexual assault: Prevalence, symptomatology, and sex differences in the general population. J Trauma Stress, 17:203-211.
16. Eyüpoğlu H (2008) Cinsel taciz ve travma. Eleştirel bir deneyim aktarımı. Eleştirel Psikoloji Bülteni, 1:53-63.
17. Fang S, Chung MC, Wang Y (2020) The Impact of Past Trauma on Psychological Distress: The Roles of Defense Mechanisms and Alexithymia. Front Psychol, 11:1-10 .
18. Feldhaus KM, Houry D, Kaminsky R (2000) Lifetime sexual assault prevalence rates and reporting practices in an emergency department population. Ann Emerg Med, 36:23-27.
19. Fırat S, Erk MA (2019) Sinsice İşlenen Bir Suç: Madde ile Kolaylaştırılmış Cinsel Saldırılar ve Fail Tipolojisi. Bull Leg Med, 24:141-147.
20. Galliano G, Noble LM, Travis LA, Puechl C (1993) Victim reactions during rape/sexual assault: A preliminary study of the immobility response and its correlates. J Interpers Violence, 8:109-114.
21. Glasier A (1997) Emergency postcoital contraception. N Engl J Med, 337:1058-1064.
22. Gostin LO, Lazzarini Z, Alexander D, Brandt AM, Mayer KH, Silverman DC (1994) HIV testing, counseling, and prophylaxis after sexual assault. JAMA, 271:1436-1444.
23. Gölge ZB, Yavuz MF, Başkan TM (2000) Hukukçuların ve Polislerin Irza Geçme ile İlgili Ceza Sistemine Bakış Açılarının Değerlendirilmesi. Bull Leg Med, 5:5-11.
24. Gölge ZB, Yavuz MF, Günay Y (1999) İlgili mesleklerden kişilerin ırza geçme ile ilgili tutum ve inanışları. Noro Psikiyatr Ars, 36:146-153.
25. Gölge ZB, Yavuz MF, Korkut S, Kahveci S (2013) Yetişkin kadın mağdurlarda cinsel saldırı sonrası görülen ruhsal ve sosyal sorunlar. Bull Leg Med, 18:82-91.
26. Hanson RK (1990) The psychological impact of sexual assault on women and children: A review. Ann. Sex Res, 3:187-232.
27. Harris, HN, Valentiner DP (2002) World assumptions, sexual assault, depression, and fearful attitudes toward relationships. J Interpers Violence, 17:286-305.
28. Holmes MM, Resnick HS, Frampton D (1998) Follow-up of sexual assault victimsAm J Obstet Gynecol, 179:336-342.
29. Janoff-Bulman R, Morgan HJ (1994) Victims' Responses to traumatic life events: An unjust world or an uncaring world?. Soc Justice Res, 7:47-68.
30. Josse E (2010) They came with two guns: the consequences of sexual violence for the mental health of women in armed conflicts. Int'l Rev. Red Cross, 92:177-196.
31. Kayı Z, Yavuz MF, Arıcan N (2000) Kadın üniversite gençliği ve mezunlarına yönelik cinsel saldırı mağdur araştırması. Bull Leg Med, 5:57-163.
32. Koss MP, Bailey JA, Yuan NP, Herrera VM, Lichter EL (2003) Depression and PTSD in survivors of male violence: Research and training initiatives to facilitate recovery. Psychol Women Q, 27:130-142.
33. Koss MP, Figueredo AJ (2004) Change in cognitive mediators of rape's impact on psychosocial health across 2 years of recovery. J Consult Clin Psychol, 72:1063-1072.
34. Krug EG, Mercy JA, Dahlberg LL, Zwi AB (2002) The world report on violence and health. Lancet, 360:1083-1088.
35. Kutlu SS, Serinken M (2010) Cinsel Yolla Bulasan Hastaliklar (CYBH) Için Acil Profilaksi Uygulamalari/Practice of Urgent Prophylaxis for Sexually Transmitted Infection (STI) s. Eurasian J Emerg Med, 9:143-147.
36. Langton L, Berzofsky M, Krebs CP, Smiley-McDonald H (2012) Victimizations not reported to the police, 2006-2010. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Available from: URL: https://www.bjs.gov/content/pub/pdf/vnrp0610.pdf. Accessed date: 01.04.2018.
37. Leithner K, Assem-Hilger E, Naderer A, Umek W, Springer-Kremser M (2009) Physical, sexual, and psychological violence in a gynaecological–psychosomatic outpatient sample: Prevalence and implications for mental health. Eur J Obstet Gynecol Reprod Biol, 144:68-172.
38. Levy-Gigi E, Richter-Levin G, Kéri S (2014) The hidden price of repeated traumatic exposure: different cognitive deficits in different first-responders. Front Behav Neurosci, 8:1-10.
39. Linden JA (2011) Care of the adult patient after sexual assault. N Engl J Med, 365:834-841.
40. Mackey T, Sereika SM, Weissfeld LA, Hacker SS, Zender JF, Heard SL (1992) Factors associated with long-term depressive symptoms of sexual assault victims. Arch Psychiatr Nurs, 6:10-25.
41. Maguire W, Goodall E, Moore T (2009) Injury in adult female sexual assault complainants and related factors. Eur J Obstet Gynecol Reprod Biol, 142:149-153.
42. Masho SW, Alvanzo A (2009) Help-Seeking Behaviors of Men Sexual Assault Survivors. Am J Mens Health, 4:237–242.
43. Morgan RE, Kena G (2018) Criminal victimization, 2016: revised. Washington, DC: Bureau of Justice Statistics. Available from: URL: https://www.bjs.gov/content/pub/pdf/cv16.pdf Accessed date:01.02.2021
44. Palmer CM, McNulty AM, D'Este C, Donovan B (2004) Genital injuries in women reporting sexual assault. Sex Health, 1:55-59.
45. Perilloux C, Duntley JD, Buss DM (2012) The costs of rape. Arch Sex Behav, 41:1099-1106.
46. Resick PA (1993) The psychological impact of rape. J Interpers Violence, 8:223-255.
47. Roberts AR (2002) Assessment, crisis intervention, and trauma treatment: The integrative ACT intervention model. Brief Treat Crisis Interv, 2:1–21.
48. Rossi PH, Waite E, Bose CE, Berk RE (1974) The seriousness of crimes: Normative structure and individual differences. Am Sociol Rev,39:224-237.
49. Rothbaum BO, Astin MC, Marsteller F (2005) Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. J Trauma Stress, 18:607-616.
50. Rothbaum BO, Foa EB, Riggs DS, Murdock T, Walsh W (1992) A prospective examination of post‐traumatic stress disorder in rape victims. J Trauma Stress, 5:455-475.
51. Ruzek JI, Brymer MJ, Jacobs AK, Layne CM, Vernberg EM, Watson PJ (2007) Psychological first aid. J Ment Health Couns, 29:17-49.
52. Sable MR, Danis F, Mauzy DL, Gallagher SK (2006) Barriers to reporting sexual assault for women and men: Perspectives of college students. J Am Coll Health, 55:157-162.
53. Schwartze D, Barkowski S, Strauss B, Knaevelsrud C, Rosendahl J (2019) Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials. Psychother Res, 29:415-431.
54. Sijbrandij M, Olff M, Reitsma JB, Carlier IV, Gersons BP (2006) Emotional or educational debriefing after psychological trauma: Randomised controlled trial. Br J Psychiatry, 189:150-155.
55. Sloan DM, Feinstein BA, Gallagher MW, Beck JG, Keane TM (2013) Efficacy of group treatment for posttraumatic stress disorder symptoms: A meta-analysis. Psychol Trauma, 5:176–183.
56. Tetik S, Kayıkçıoğlu F, Koçer M, Tekin ÖM (2019) Etlik Zübeyde Hanım Sağlık Uygulama Araştırma Merkezi Acil Servisi'ne 2014-2017 Yılları Arasında Adli Makamlarca Yönlendirilen Cinsel Saldırı Vakalarının İncelenmesi. Turkiye Klinikleri J Foren Sci Leg Med., 16:37-44.
57. Tillman S, Bryant-Davis T, Smith K, Marks A (2010) Shattering silence: Exploring barriers to disclosure for African American sexual assault survivors. Trauma Violence Abuse, 11:59-70.
58. Tjaden PG, Thoennes N (2006) Extent, nature, and consequences of rape victimization: Findings from the National Violence Against Women Survey. Available from: URL: https://stacks.cdc.gov/view/cdc/21950. Accessed date:01.02.2021
59. Vu A, Adam A, Wirtz A, Pham K, Rubenstein L, Glass N et al. (2014) The prevalence of sexual violence among female refugees in complex humanitarian emergencies: a systematic review and meta-analysis. PLoS Curr, 6:1-17.
60. Wei Y, Szumilas M, Kutcher S (2010) Effectiveness on mental health of psychological debriefing for crisis intervention in schools. Educ Psychol Rev, 22:339-347.
61. Welch J, Mason F (2007) Rape and sexual assault. BMJ, 334:1154-1158.
62. Wessely S, Rose S, Bisson J (2000) Brief psychological interventions (" debriefing") for trauma-related symptoms and the prevention of post traumatic stress disorder. Cochrane Database Syst Rev, (2), CD000560.
63. Wolf ME, Ly U, Hobart MA, Kernic MA (2003) Barriers to seeking police help for intimate partner violence. J Fam Violence, 18:121-129.
64. World Health Organization (2002) World Report on Violence and Health, Chapter 6: Sexual Violence. World Health Organization. Available from: URL:https://www. who. int/violence_injury_prevention/violence/global_campaign/en/chap6. pdf. Accessed date: 01.04.2018.
65. World Health Organization (2013) Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. Available from: URL:https://apps.who.int/iris/bitstream/handle/10665/85240/9789241548595_eng.pdf?sequence=1. Accessed date: 01.04.2018.
66. World Health Organization (2020) Sexual and Reproductive Health. Available from: URL:https://www.who.int/reproductivehealth/topics/violence/sexual_violence/en/. Accessed date: 01.02.2021.
67. Workowski KA (2015) Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis, 61, S759-S762.
68. Yılmaz E, Çelikel A, Değirmenci B, Zeren C, Gören S (2011) Diyarbakırda Cinsel Suç Mağduru Olguların Değerlendirilmesi. Bull Leg Med, 16:93-103.
69. Yüksel Kaptanoğlu İ, Çavlin A, Akadlı Ergöçmen B (2015) Türkiye’de Kadına Yönelik Aile içi Şiddet Araştırması. Available from: URL:http://www.hips.hacettepe.edu.tr/siddet2014/rapor/KKSA-TRAnaRaporKitap26Mart.pdf. Accessed date: 01.04.2018.