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Talk to adolescents about sexual assault.

SEATTLE -- Recent events have highlighted the issue of sexual assault in adolescents. But the onus still is on psychiatrists and other clinicians to ask patients whether they've ever been a victim of sexual assault or other kinds of trauma, according to an expert.

"It turns out that these experiences are common for kids, and they're very correlated with the development of all kinds of psychiatric disorders. And if we ask, they will tell us. If we don't ask they probably won't," said Lucy Berliner, director of the Harborview Center for Sexual Assault and Traumatic Stress, who discussed the epidemiology of sexual trauma in adolescents at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

A common misconception is that victims of sexual assault have endured multiple, chronic traumas. A more common scenario, however, is a single incident, much like the one described by Christine Blasey Ford, PhD, in her testimony before Congress, and clinicians should be more on the lookout for such cases. "I think those young people get a little bit lost," Ms. Berliner said at the meeting.

A 2001 study of adolescents (aged 12-17) who reported and sought treatment for sexual assault in the Seattle area found that 54% of cases resulted from a single incident.

Unlike the incident described by Dr. Ford, coercion often was not physical. Fifty-two percent of the time, the adolescents experienced abuse by authority figures, such as an assault by a teacher or coach, or even someone who used social advantage such as being older or more popular. In 17% of the cases, the victim was drugged or unconscious. Physical restraint was reported in 20% of cases. Weapons were involved only 7% of the time.

Twenty-eight percent of the adolescents were victims of a teenager, compared with 54% who attributed the assault to an adult. Overall, 72% of the subjects presented at an emergency department rather than a counseling clinic, which suggests that screening in medical environments also is a key factor in identifying and responding to people who have been assaulted.

All study subjects were offered counseling, but the uptake was low: The median was 2 sessions.

"My guess is that in the beginning, a lot of people say, 'I just want to put it behind me, or I want to try to figure it out myself,' and it only comes around later, in mental health settings, where these kids are in there for some type of psychiatric disorder. And unless we ask, we're not going to find out (about a previous assault), and we won't be able to give them the help that would help them with this psychiatric disorder," said Ms. Berliner, also a clinical associate professor at the University of Washington School of Social Work in Seattle.

Clinicians might not ask about these experiences, she said, because of fears of triggering raw emotions. But such fears are unfounded, she stated. "We need to get over ourselves," Ms. Berliner said. "If we don't create the opportunity, why would they tell us? And if they don't want to tell us, they won't. But you can't traumatize a kid by talking about something that's already actually happened to them."

That point can even extend to the legal system. Also during the session, Emily Petersen, senior deputy prosecuting attorney in the Special Assault Unit in King County, Washington, emphasized that, in her experience, young people who are victims of sexual and other forms of assault are resilient--and they will not be traumatized by speaking with a prosecutor or to police about their experiences.

But the legal system cannot provide healing, she and Ms. Berliner noted. That must come from the victim's support system. "These experiences don't have to define victims of sexual assault as long as the adults in their lives are responding appropriately to them," Ms. Petersen said.

Ms. Berliner and Ms. Petersen disclosed no conflicts of interest.



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Title Annotation:WOMEN'S HEALTH
Author:Kling, Jim
Publication:Family Practice News
Date:Nov 1, 2018
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