Helping Individuals Heal from Rape Connected to Conflict and/or War

  • Meghan E. McDevitt-Murphy
  • Laura B. Casey
  • Pam Cogdal


Rape and sexual assault have been employed as weapons of war in recent conflicts. The effects on individuals, communities, and cultures can be devastating. Sexual assault is associated with high risk for posttraumatic stress disorder and other adverse outcomes. Some of the contextual factors (i.e., displacement, widespread fear and terror, multiple other forms of trauma, disrupted social support networks) related to war can only expound those effects. This chapter offers some guidance for clinicians working with survivors of war-related rape. Clinicians are advised to be sensitive to cultural and socio-political factors that will vary based on locale. The chapter includes information about assessment and treatment and describes one treatment approach (narrative exposure therapy) that has been successfully used in a chaotic war-torn environment.


Sexual Assault Ptsd Symptom Sexual Violence Exposure Therapy Sexual Trauma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ahrens, C. E. (2006). Being silenced: the impact of negative social reactions on the disclosure of rape. American Journal of Community Psychology, 38, 263–274.CrossRefGoogle Scholar
  2. Bisson, J. I., Jenkins, P. L., Alexander, J., & Bannister, C. (1997). Randomized controlled trial of psychological debriefing for victims of acute burn trauma. British Journal of Psychiatry, 171, 78–81.CrossRefGoogle Scholar
  3. Borja, S. E., Callahan, J. L., & Long, P. J. (2006). Positive and negative adjustment and social support of sexual assault survivors. Journal of Traumatic Stress, 19, 905–914.CrossRefGoogle Scholar
  4. Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995). The development of a clinician administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.CrossRefGoogle Scholar
  5. Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multi-dimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214–227.CrossRefGoogle Scholar
  6. Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48(3), 216–222.Google Scholar
  7. Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68, 748–766.CrossRefGoogle Scholar
  8. Bryant, R. A., Harvey, A. G., Dang, S. T., Sackville, T., & Basten, C. (1998). Treatment of acute stress disorder: A comparison of cognitive-behavioral therapy and supportive counceling. Journal of Consulting and Clinical Psychology, 66(5), 862–866.CrossRefGoogle Scholar
  9. Castillo, R. J. (1997). Culture and Mental Illness: A Client-Centered Approach. Pacific Grove, CA: Brooks/Cole.Google Scholar
  10. Coomaraswamy, R. (1999). Integration of the human rights of women and the gender perspective: Violence against women. New York: United Nations Commission on Human Rights.Google Scholar
  11. Dunmore, E., Clark, D. M., & Ehlers, A. (2001). A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical assault. Behaviour Research and Therapy, 39, 1063–1084.CrossRefGoogle Scholar
  12. Farr, K. (2009). Extreme war rape in today’s civil-war-torn states: A contextual and comparative analysis. Gender Issues, 26, 1–41.CrossRefGoogle Scholar
  13. First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (1996). Structured clinical interview for DSM-IV Axis I disorders – Patient version. New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
  14. Fisher, J. E., & O’Donohue, W. T. (Eds.). (2006). Practitioner’s guide to evidence-based psychotherapy. New York: Springer.Google Scholar
  15. Foa, E. B. (1995). Posttraumatic Stress Diagnostic Scale [Manual]. Minneapolis, MN: National Computer Systems.Google Scholar
  16. Foa, E. B., Hearst-Ikeda, D., & Perry, K. J. (1995). Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. Journal of Consulting and Clinical Psychology, 63, 948–955.CrossRefGoogle Scholar
  17. Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A., Riggs, D. S., Feeny, N. C., et al. (2005). Randomized trial of prolonged exposure for PTSD with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953–964.CrossRefGoogle Scholar
  18. Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences. New York: Oxford University Press.Google Scholar
  19. Foa, E. B., & Rothbaum, B. O. (2001). Treating the trauma of rape. New York: Guilford Press.Google Scholar
  20. Follette, V. M. & Ruzek, J. I. (2006). Cognitive-behavioral therapies for trauma (2nd ed.). New York: Guilford Press.Google Scholar
  21. Foy, D. W. (1992). Treating PTSD: Cognitive-behavioral strategies. New York: Guilford Press.Google Scholar
  22. Golding, J. M., Siegel, J. M., Sorenson, S. B., Burnam, M. A., & Stein, J. A. (1989). Social support sources following sexual assault. Journal of Community Psychology, 17, 92–107.CrossRefGoogle Scholar
  23. Gottschall, J. (2004). Explaining wartime rape. Journal of Sex Research, 41, 129 –136.CrossRefGoogle Scholar
  24. Hensley, L. (2002). Treatment for survivors of rape: Issues and interventions. Journal of Mental Health Counseling, 24, 330–347.Google Scholar
  25. Hustache, S., Moro, M. R., Roptin, J., Souza, R., Gansou, G. M., Mbemba, A., et al. (2009). Evaluation of a psychological support for victims of sexual violence in a conflict setting: Results from Brazzaville, Congo. International Journal of Mental Health Systems, 3, 1–10.CrossRefGoogle Scholar
  26. Kerimova, J., Posner, S. F.., Brown, Y. T., Hillils, S., Meikle, S., & Duerr, A. (2003). High prevalence of self-reported sexual intercourse among internally displaced women in Azerbaijan. American Journal of Public Health, 93, 1067–1070.CrossRefGoogle Scholar
  27. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Post-traumatic stress disorder in the National Co-morbidity Survey. Archives of General Psychiatry, 52, 1048–1060.Google Scholar
  28. Lepore, S. J., Ragan, J. D., & Jones, S. (2000). Talking facilitates cognitive-emotional processes of adaptation to an acute stressor. Journal of Personality and Social Psychology, 78, 499–508.CrossRefGoogle Scholar
  29. Littlewood, R. (1997). Military Rape. Anthropology Today, 13, 7–17.CrossRefGoogle Scholar
  30. Maman, S., Mbwambo, J., Hogan M., Kilonzo, G., Sweat, M., & Weiss, E. (2001). HIV and Partner Violence: Implications for HIV Voluntary Counselling and Testing Programs in Dar es Salaam, Tanzania. New York: The Population Council Inc.Google Scholar
  31. Marks, I., Lovell, K., Noshirvani, H., Livanou, M. & Thrasher, S. (1998). Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Archives of General Psychiatry, 55, 317–325.CrossRefGoogle Scholar
  32. Najdowski, C. J., & Ullman, S. E. (2009). PTSD symptoms and self-rated recovery among adult sexual assault survivors: The effects of traumatic life events and psychosocial variables. Psychology of Women Quarterly, 33, 43–53.CrossRefGoogle Scholar
  33. National Center for Victims of Crime (1995). “Male Rape,” FYI, Arlington, VA: Author.Google Scholar
  34. National Center for Victims of Crime & Crime Victims Research and Treatment Center. (1992). Rape in American: A report to the nation. Arlington, VA: National Center for Victims of Crime.Google Scholar
  35. Neill, K. G. (2000). Duty, honor, rape: Sexual assault against women during war. Journal of International Women’s Studies, 2(1). Available from
  36. Nemeroff, C. B., Bremner, J. D., Foa, E. B., Mayberg, H. S., North, C. S., & Stein, M. B. (2006). Posttraumatic stress disorder: A state-of-the-science review. Journal of Psychiatric Research, 40, 1–21.CrossRefGoogle Scholar
  37. Neuner, F., Onyut, P. L., Ertl, V. Odenwald, M., Schauer, E. & Elbert, T. (2008). Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 686–694.CrossRefGoogle Scholar
  38. Neuner, F., Schauer, E., Elbert, T., & Roth, W. T. (2002). A narrative exposure treatment as intervetntion in a Macedonian refugee camp: A case report. Journal of Behavioural and Cognitive Psychotherapy, 30, 205–209.Google Scholar
  39. Pennybaker, J. W. (1993). Putting stress into words: Health, linguistic, and therapeutic implications. Behaviour Research and Therapy, 31, 539–548.CrossRefGoogle Scholar
  40. Rehn, E., & Sirleaf, E. J. (2002). Women, war, and Peace: The independent experts’ assessment on the impact of armed conflict on women and women’s role in peace-building. New York: United Nations Development Fund for Women.Google Scholar
  41. Resick, P. A., Calhoun, K., Atkeson, B., & Ellis, E. (1981). Adjustment in victims of sexual assault. Journal of Consulting and Clinical Psychology, 49, 704–712.CrossRefGoogle Scholar
  42. Resick, P. A., & Schnicke, M. K. (1993). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748–756.Google Scholar
  43. Riggs, D. S., Rothbaum, B. O., & Foa, E. B. (1995). A prospective examination of symptoms of posttraumatic stress disorder in victims of nonsexual assault. Journal of Interpersonal Violence, 10, 201–214.CrossRefGoogle Scholar
  44. Roberts, B., Ocaka, K. F., Browne, J., Oyok, T., & Sondorp, E. (2008). Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda. BMC Psychiatry, 8, 38. Available from:
  45. Roth, S., & Lebowitz, L. (1988). The experience of sexual trauma. Journal of Traumatic Stress, 1, 79–107.CrossRefGoogle Scholar
  46. Rothbaum, B. O., Foa, E. B., Riggs, D., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455–475.CrossRefGoogle Scholar
  47. Salzman, T. A. (1998). Rape camps as a means of ethnic cleansing: religious, cultural, and ethical responses to rape victims in the former Yugoslavia. Human Rights Quarterly, 20, 348–378.CrossRefGoogle Scholar
  48. Schnurr, P. P., Friedman, M. J., Engel, D. C., Foa, E. B., Shea, M. T., Resick, P. A., et al. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. Journal of the American Medical Association, 297, 820–830.CrossRefGoogle Scholar
  49. Schulz, P. M., Resick, P. A., Huber, C. L., & Griffin, M. G. (2006). The effectiveness of cognitive processing therapy for PTSD with refugees in a community setting. Cognitive and Behavioral Practice, 13(4), 322–331.CrossRefGoogle Scholar
  50. Seifert, R. (1996). The second front: the logic of sexual violence in wars. Women’s Studies International Forum, 19, 35–42.CrossRefGoogle Scholar
  51. Shea, M. T., McDevitt-Murphy, M. E., Schnurr, P., & Ready, D. (2008). Group therapy for PTSD. In E. B. Foa, M. J. Friedman, & T. M. Keane (Eds.), Effective Treatments for PTSD (pp. 306–326). New York: Guilford.Google Scholar
  52. Starzynski, L. L., Ullman, S. E., Filipas, H. H., & Townsend, S. M. (2005). Correlates of women’s sexual assault disclosure to formal and informal support sources. Violence and Victims, 20, 417–432.CrossRefGoogle Scholar
  53. Stuijt, A. (2009). Gang rape: A youth cult in South African townships. Retrieved from
  54. Suris, A., Lind, L., Kashner, M., Borman, P. D., & Petty, F. (2004). Sexual assault in women veterans: An examination of PTSD risk, health care utilization, and cost of care. Psychosomatic Medicine, 66, 749–756.CrossRefGoogle Scholar
  55. Taylor, S. (2006). Clinician’s guide to PTSD: A cognitive-behavioral approach. New York: Guilford Press.Google Scholar
  56. Ullman, S. E. (2007). Asking research participants about trauma and abuse. American Psychologist, 62, 329–330.CrossRefGoogle Scholar
  57. Ullman, S. E., Townsend, S. M., Filipas, H. H., & Starzynski, L. L. (2007). Structural models of thre relations of assault severity, social support, avoidance coping, self-blame, and PTSD among sexual assault survivors. Psychology of Women Quarterly, 31, 23–37.CrossRefGoogle Scholar
  58. United Nations Development Fund for Women (UNIFEM). (2007). Violence against women: Facts and Figures. Retrieved from
  59. United Nations Development Fund for Women (UNIFEM). (2009). Preventing wartime rape from becoming a peacetime reality retrieved from
  60. Weathers, F. W., Keane, T. M., & Foa, E. B. (2008). Assessment and diagnosis of adults. In E. B. Foa, M. J. Friedman, & T. M. Keane (Eds.). Effective Treatments for PTSD (pp. 23–61). New York: Guilford.Google Scholar
  61. Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist: Reliability, validity, and diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
  62. Weathers, F. W., Newman, E., Blake, D. D., Naby, L. M., Schnurr, P. P., Kaloupek, D. G., et al. (2004). Clinician-Administered PTSD Scale (CAPS) – Interviewer’s guide. Los Angeles: Western Psychological Services.Google Scholar
  63. Wilson, J. P., & Keane, T. M. (Eds.). (2004). Assessing Psychological Trauma and PTSD. New York: Guliford.Google Scholar
  64. Wolfe, J., Sharkansky, E. J., Read, J. P., Dawson, R., Martin, J. A., & Ouimette, P. C. (1998). Sexual harassment and assault as predictors of PTSD symptomatology among U.S. female Persian Gulf War military personnel. Journal of Interpersonal Violence, 13, 40–57.CrossRefGoogle Scholar
  65. Wood, E. J. (2006). Variation in sexual violence during war. Politics & Society, 34(3), 307–341.CrossRefGoogle Scholar
  66. World Health Organization. (2001). Rapid assessment of mental health needs of refugees, displaced, and other populations affected by conflict and post-conflict situations: A community oriented assessment. Geneva: author.Google Scholar
  67. Zayfert, C., & Becker, C. B. (2007). Cognitive-behavioral therapy for PTSD: A case formulation approach. New York: Guilford Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Meghan E. McDevitt-Murphy
    • 1
  • Laura B. Casey
    • 1
  • Pam Cogdal
    • 1
  1. 1.University of MemphisMemphisUSA

Personalised recommendations