Women With Severe Mental Illness and Marital Rape

Abstract

Marital rape has been socially and culturally normalized within marriage. It becomes a subtle form of violence against women with severe mental illness who cannot negotiate on sexual matters with their partner. This study aims to critically analyze empirical studies to see how women with severe mental illness can be at risk of being sexually abused by their intimate partner, its impact on their life, what protects them from abuse, historical framework, the role of mental health professionals, need of research on marital rape of men and a way forward. Mental health professionals need to consider all these factors and provide community-coordinated care and support.

An ecological approach to understanding the impact of sexual violence: a systematic meta-review

“…However, differences in depression and suicidal ideation between survivors and controls are not consistently confirmed in some reviews (Ullman, 2004 ; Ribeiro et al, 2009 ; Beydoun et al, 2012 ; Dillon et al, 2013 ; Finneran and Stephenson, 2013 ; Wadsworth and Records, 2013 ; Sparrow et al, 2017 ; Paulson, 2020 ; Forkus et al, 2021 ; Lim et al, 2022 ; Lombardi et al, 2023 ). Survivors also report feeling increased anger according to some reviews (Godier-McBard and Jones, 2020 ; Kahsay et al, 2020 ; Klein and Martin, 2021 ; Rani et al, 2022 ).…”

“…More than one in 20 survivors to three-quarter of survivors report anxiety or anxiety-related behavioral changes, such as taking precautions to prevent experiencing another victimization, following the assault. Effect sizes comparing survivors to controls on anxiety symptoms range from small to large (Campbell et al, 2000 ; Ribeiro et al, 2009 ; Chen et al, 2010 ; Peterson et al, 2011 ; Wadsworth and Records, 2013 ; Larijani and Guggisberg, 2015 ; Ba and Bhopal, 2017 ; Chmielowska and Fuhr, 2017 ; Bows, 2018 ; Dworkin, 2018 ; Pulverman et al, 2019 ; Stewart et al, 2019 ; Dame et al, 2020 ; Kahsay et al, 2020 ; Pebole et al, 2021 ; Nicholas et al, 2022 ; Rani et al, 2022 ; Spencer et al, 2023 ). However, in some cases depression and anxiety are combined into one measure resulting in a combined effect size for both.…”

“…According to numerous reviews, up to two thirds of survivors report depressive symptoms and almost two in five patients with depression report having experienced ASA. In addition, when comparing survivors vs. controls and survivors of other trauma types, small to large effect sizes in depressive symptoms are found (Goodman et al, 1997 ; Campbell et al, 2000 ; Van Berlo and Ensink, 2000 ; Ullman, 2004 ; Classen et al, 2005 ; Ribeiro et al, 2009 ; Chen et al, 2010 ; Peterson et al, 2011 ; Beydoun et al, 2012 ; Dillon et al, 2013 ; Finneran and Stephenson, 2013 ; Mauritz et al, 2013 ; Wadsworth and Records, 2013 ; Alvarez-Segura et al, 2014 ; Ba and Bhopal, 2017 ; Chmielowska and Fuhr, 2017 ; Dworkin et al, 2017 ; Bows, 2018 ; Dworkin, 2018 ; Pulverman et al, 2019 ; Shamblaw et al, 2019 ; Dame et al, 2020 ; Godier-McBard and Jones, 2020 ; Kahsay et al, 2020 ; Paulson, 2020 ; Forkus et al, 2021 ; Klein and Martin, 2021 ; Mazza et al, 2021 ; Diez-Canseco et al, 2022 ; Klein et al, 2022 ; Nicholas et al, 2022 ; Rani et al, 2022 ; Lombardi et al, 2023 ; Spencer et al, 2023 ). In addition, 37% of patients with bipolar disorder report having experienced ASA, and a small to large effect size is found when comparing the bipolar disorder prevalence in survivors and controls (Mauritz et al, 2013 ; Dworkin et al, 2017 ).…”

“…Six reviews found that survivors had a less positive self-perception (e.g., lower physical self-image, self-esteem, self-worth and self-respect) than healthy controls and survivors of other trauma types. In addition, 32.0% of survivors report negative self-perceptions (Campbell et al, 2000 ; Peterson et al, 2011 ; Finneran and Stephenson, 2013 ; Kouyoumdjian et al, 2013 ; Bows, 2018 ; Kahsay et al, 2020 ; Kouvelis and Kangas, 2021 ; Rani et al, 2022 ).…”

“…A total of 15 reviews investigate the association of sexual violence with negative interpersonal changes including three reporting on general social changes . As such, sexual violence is shown to be associated with social isolation (Kahsay et al, 2020 ; Rani et al, 2022 ; Davis et al, 2023 ). In addition, it was found that 10.0%−60.0% of survivors report social dysfunction (Ba and Bhopal, 2017 ) and that 66.0%−75.0% report distrust of others, 20.0% report withdrawal from social activities and 80.0% made social changes (e.g., joining a religious group, joining delinquent peer groups, avoiding areas; Peterson et al, 2011 ).…”