Hypothesis 2: Impaired emotional and eognitive processing during the rape

It was hypothesised that the anxiolytic, amnestic and sedative effects o f the drugs would significantly impair cognitive and emotional processing, leading to confusion and low levels o f ‘criterion A emotions’, particularly fear, during the assault. This hypothesis was supported by the results, which are discussed below, in relation to both fear and helplessness.

Peritraumatic helplessness and PTSD

As anticipated, perceived helplessness at the time o f the trauma was high. This may reflect known effects o f these drugs, including mental confusion, disinhibition o f behaviour, muscle relaxation and sedation. GBH, in particular, has powerful muscle relaxant effects, which could render a victim completely physically incapacitated whilst they remain conscious. Although rated as high during the assaults, helplessness was not significantly associated with PTSD severity, a finding that differs from previous research with ‘non-drug’ trauma victims, which has demonstrated that helplessness and uncontrollability are powerful predictors o f PTSD (Foa et al, 1989; Ehlers and Clark, 2000). Reynolds and Brewin (1999) found that, whilst fear was associated with intrusive memories in both depressed and PTSD populations, helplessness was uniquely associated with PTSD symptomatology. In a retrospective analysis o f emotional responses during trauma (Criterion A2: N = 85), Roemer et al (1998), also found helplessness to significantly predict arousal, avoidance and re-experiencing symptoms of PTSD.

There are alternative explanations as to why peritraumatic helplessness, although rated highly by participants, was not predictive o f PTSD severity in this research. Firstly, ratings o f peritraumatic helplessness were retrospective, and may therefore have been subject to recall bias, particularly given the extent o f amnesia reported. Also,

participants may have perceived themselves as having felt extreme helplessness during the rape as a result o f post-hoc appraisals, when this was not truly the ease. Alternatively, the effects o f the drugs on eognitive and affective processing may have mediated a different relationship between peritraumatic affect and subsequent PTSD to other trauma populations.

Peritraumatic fear and PTSD

The majority o f partieipants also reported experieneing extremely low levels o f fear during the rape, with 48% reporting no fear. This important finding suggests that covertly administered drugs significantly reduce fear, and are anxiolytic, even in situation as extreme and traumatic as rape.

A third o f participants (35%) did not meet DSM-IV criterion Al^ and, notably, 65.5% reported that they did not fear for their lives during the rape. Pereeived life threat or physical injury at the time o f trauma is currently conceptualised as a DSM-IV criteria for PTSD diagnosis (criterion Al). As a result, a high proportion o f survivors did not fulfil diagnostic criteria for PTSD. Survivors’ comments, including, ""not being able to think or fe e l anything at all, I ju s t fe lt overwhelmed and confused” and being ""too confused to be distressed” illustrate the moderating effects o f the drugs on cognitive proeessing during rape. Ehlers and Clark (2000) use the term “data-driven processing” to refer to such low levels o f semantic or conceptual processing during trauma. The low reports o f perceived life threat eontrast sharply with other, ‘non-drug’ rape populations, where reported threat to integrity is extremely high (e.g. Rothbaum et al, 1992).

Overall, 34.5% o f participants failed to meet both DSM-IV criterion A l and A2^, and could not fulfil the diagnostic criteria for PTSD. Importantly, no significant difference in PTSD severity (intrusions, arousal and avoidance) was identified between those participants who did or did not meet DSM-IV criterion A l and/ or A2, with both sub­ groups reporting moderate-severe PTSD symptomatology. This pattern o f results indicates that experiencing intense primary (criterion A) emotions during the trauma and/ or perceived life threat at the time was not essential for the subsequent development o f PTSD. This is an interesting finding, given that current cognitive conceptualisations o f PTSD (e.g. Dual Representation Theory, Brewin et al, 1996; DSM-IV, APA, 1994) propose the experiencing o f ‘primary emotions’ to underpin the development o f SAM^ and PTSD re-experiencing symptoms. Roemer et al (1998: 128) highlight the lack o f theoretical and empirical validity o f current DSM-IV criteria for PTSD: “given that the three emotions included in D SM -IV were not empirically derived, an investigation into the role a range o f emotional reactions play in the development o f PTSD is indicated [including numbing]

Post-hoc exploration o f the data revealed that peritraumatic fear, although low for the majority o f participants, showed a significant negative relationship with PTSD. This result also differs from much o f the existing empirical research with survivors o f trauma. For example, in a longitudinal study o f victims o f violent crime (N = 138), Brewin et al (2000) found that intense fear was significantly, and positively, associated with PTSD severity. Although much empirical research has found intense peritraumatic affect to predict PTSD severity, a growing body o f empirical literature has shown that ‘emotional numbing’ (e.g. significantly reduced fear) during trauma also predicts PTSD, as found for drug-rape survivors. For example, Roemer et al (1998) found, in a sample o f college

^ Intense fear, h elp lessn ess or horror experienced during the trauma ^ Situationally accessib le m em ory

students, that emotional numbing (rated on a 9-point Likert scale) was predictive o f PTSD severity in a retrospective study, and notes that this might represent the effects o f peritraumatic dissociation. As found by Roemer et al (1998), the results o f the current research suggest that a lower fe a r response during drug-rape might exacerbate, rather than reduce, PTSD symptomatology.

Brewin et al (2000) also note that alternative psychological or biological processes could facilitate the development o f PTSD in the absence o f intense peritraumatic affect. In their longitudinal study o f peritraumatic emotions and PTSD in victims o f violent crime, a small proportion o f participants did not report intense affect yet had PTSD o f comparable severity. These participants reported maximum posttraumatic shame and anger scores, suggesting that posttraumatic appraisals may have mediated PTSD symptomatology in the absence o f peritraumatic affect. The mediating role o f different negative appraisals reported by drug-rape survivors in PTSD symptomatology is discussed below.