Drug-facilitated sexual assault, impaired trauma memory, and implications for mental health treatment

Figures & data

Table 1. Sexual assault subgroup labels and classification criteria.

Subgroup label [synonyms^a]	Classification criteria
DFSA-I: Drug-Facilitated Sexual Assault-Involuntary Ingestion [predatory DFSA; proactive DFSA; drug-or-alcohol- facilitated rape-DAFR]	Survivor knew they were given substance(s) against their will, or Survivor learned they were given substance(s) without their knowledge, or Survivor suspected 1 or 2, and had at least one incapacitation symptom Survivor may or may not have also ingested substances voluntarily
DFSA-V: Drug-Facilitated Sexual Assault-Voluntary Ingestion [opportunistic DFSA; non-predatory DFSA; incapacitated rape; impaired rape]	Survivor had voluntary substance use, and Survivor had at least one incapacitation symptom, and Survivor did not know or suspect they were given additional substance(s) against their will or without their knowledge
NDFSA: Non-Drug-Facilitated Sexual Assault [forcible rape]	Survivor may or may not have ingested substances voluntarily, and Survivor did not know or suspect they were given substances against their will or without their knowledge, and Survivor did not have incapacitation symptoms

Note: Incapacitation symptoms include partial/total amnesia, nausea/vomiting, drowsy, dizzy, altered motor function, loss of consciousness, hallucinations (adapted from Du Mont et al., 2009).

^a Terminology utilized across SA research literature for each of the three types of SA.

Table 2. Logistic regression analyses comparing assault groups on sociodemographics, assault characteristics, substance use, and SA history.

Variable	Total N(N = 74)		DFSA-I(n =  26)		DFSA-V(n = 16)		NDFSA(n = 32)		Overall group effect			Pairwise group comparisons
												DFSA-I vs. DFSA-V		DFSA-I vs. NDFSA		DFSA-V vs. NDFSA
	n	%	n	%	n	%	n	%	x^2(2)	p	V^a	OR	p	OR	p	OR	p
												(95% CI)		(95% CI)		(95% CI)
Gender (male)	6	8.1	4	15.4	2	12.5	0	0.0	7.20	.03	.21	1.18	.86	–	–	–	–
												(.19–7.37)		–		–
Lesbian/Gay/Bisexual	15	20.3	6	23.1	2	12.5	7	21.9	1.57	.46	.18	2.63	.28	1.02	.98	0.39	.28
												(.45–15.16)		(.28–3.65)		(.07–2.16)
Ethnicity
African American	8	10.8	2	7.7	3	18.8	3	9.4	1.14	.57	.11	0.38	.32	0.81	.83	2.15	.38
												(.06–2.56)		(.13–5.28)		(.38–12.15)
Asian/Pacific Islander	7	9.5	4	15.4	2	12.5	1	3.1	3.05	.22	.15	1.33	.76	5.71	.13	4.29	.25
												(.21–8.29)		(.6–54.82)		(.36–51.32)
Caucasian	37	50.0	13	50.0	9	56.3	15	46.9	0.27	.87	.08	0.84	.79	1.16	.79	1.37	.51
												(.24–2.98)		(.40–3.32)		(.41–4.61)
Latinx	14	18.9	4	15.4	1	6.3	9	28.1	4.12	.13	.17	2.86	.37	0.47	.26	0.16	.10
												(.29–28.20)		(.12–1.75)		(.02–1.42)
Other	6	8.1	2	7.7	1	6.3	3	9.4	0.17	.92	.07	1.30	.83	0.81	.83	0.62	.69
												(.11–15.69)		(.13–5.28)		(.06–6.51)
Unemployed	24	32.4	5	19.3	8	50.0	11	34.4	5.09	.08	.24	0.21	.03	0.46	.20	2.18	.22
												(.05–.85)		(.13–1.54)		(.63–7.61)
Uninsured	24	32.4	7	26.9	10	62.5	7	21.9	7.35	.03	.24	0.22	.03	1.25	.72	5.71	.01
												(.05–.88)		(.36–4.31)		(1.44–22.6)
Weapon used during assault	6	8.1	1	3.9	1	6.3	4	12.5	0.98	.61	.17	0.85	.91	0.39	.42	0.46	.50
												(.05–15.16)		(.04–3.84)		(.05–4.59)
Moderate or severe injury	13	17.6	3	11.5	5	31.3	5	15.6	2.26	.32	.22	0.30	.14	0.60	.52	2.00	.34
												(.06–1.49)		(.13–2.82)		(.48–8.40)
Intact memory of assault	56	75.7	16	61.5	11	68.8	29	90.6	7.68	.02	.31	0.73	.63	0.17	.01	0.23	.07
												(.19–2.72)		(.04–.69)		(.05–1.12)
Childhood sexual abuse	38	51.4	10	38.5	10	62.5	18	56.3	3.47	.18	.22	0.31	.09	0.49	.18	1.56	.50
												(.08–1.19)		(.17–1.40)		(.43–5.60)
Prior adult assault	29	39.2	9	34.6	6	37.5	14	43.8	0.85	.66	.13	0.79	.73	0.61	.36	0.76	.67
												(.21–2.95)		(.21–1.78)		(.22–2.68)
Any substance use diagnosis	27	36.5	8	30.8	11	68.8	8	25.0	8.82	.01	.27	0.20	.02	1.28	.68	6.33	<01
												(.05–.78)		(.40–4.07)		(1.68–23.8)
Substance abuse diagnosis	11	14.9	4	15.4	3	18.8	4	12.5	0.28	.87	.10	0.79	.78	1.23	.79	1.56	.60
												(.15–4.09)		(.28–5.48)		(.30–8.00)
Substance dependence diagnosis	19	25.7	6	23.1	8	50.0	5	15.4	6.89	.03	.24	0.26	.05	1.56	.51	5.94	.01
												(.07–1.03)		(.42–5.85)		(1.47–24.0)

Note: Participants were on average 29.51 years old (SD = 8.81); participant age did not differ by group.

DFSA-I = drug-facilitated sexual assault, involuntary ingestion; DFSA-V = drug-facilitated sexual assault, voluntary ingestion; NDFSA = non-drug-facilitated sexual assault. Some pairwise group comparisons could not be calculated because there were no males in the NDFSA group.

^a Cramer’s V.

Table 3. Trauma cognitions and treatment goals coded from chart review.

Trauma cognitions	Code description	DFSA-I n	DFSA-I %	DFSA-V n	DFSA-V %	NDFSA n	NDFSA %
Self-blame	Demonstrating hindsight bias; anger towards oneself; guilt and responsibility	25	33.3	21	28.6	22	29.7
Anger	Anger towards perpetrator and other trauma-related reminders	2	2.6	7	9.5	8	10.8
Difficulties in relationships	Trust issues; internalized stigma and fear of judgment; preoccupation with others’ perceptions; loss of interest in sex	49	66.7	18	23.8	18	24.3
Memory difficulties	No/partial memory; questioning what happened; difficulty labelling the event	6	7.7	4	4.8	4	5.4
Fear/safety concerns	Safety concerns; desire to feel independent and OK; generalized fear towards a group; Loss of power and control	19	25.6	32	42.9	4	5.4
Depressive thoughts	Lowered self-worth; feeling violated; suicidal ideation; lack of motivation; hopelessness; self-sabotage	8	10.3	21	28.6	10	13.5
Emotion regulation	Difficulty regulating emotions; dramatic mood swings; minimizing/numbing	0	0	7	9.5	6	8.1
Treatment goals	Code description	DFSA-I n	DFSA-I %	DFSA-V n	DFSA-V %	NDFSA n	NDFSA %
Trauma and emotional processing	Desire to deal with distressing emotions (e.g. trapped pain), stabilize mood swings, anxiety and depression, expressing a desire to ‘deal with trauma’ and not avoid anymore/accept	36	48.3	38	51.0	42	56.4
Address substance use	Desire to decrease substance use; acknowledgement that substances may have played a role	4	5.8	14	19.2	6	7.5
Improve safety	Reduce risk of re-victimization; feel psychologically safe	3	3.5	8	10.6	9	11.7
Improve relationships	Trust issues; generalized negative views of others; desire for connectedness/struggling with loneliness; boundaries	14	18.4	17	23.4	13	17.0
Self-esteem	Desire to ‘go back to normal’; Gain confidence, become independent, address violated aspects of self (moral injury); worthlessness; distressing shame/guilt	12	16.0	8	10.6	9	11.7
Memory concerns	Trying to remember; trying to accept lack of memory; confusion	2	2.3	2	2.1	0	0
Other goals	Improving quality of life, secondary benefits, getting a job	13	17.2	9	12.8	4	5.3

Note: DFSA-I = drug-facilitated sexual assault involuntary ingestion; DFSA-V = drug-facilitated sexual assault voluntary ingestion; NDFSA = non-drug-facilitated sexual assault; n = frequency of chart mentions on each trauma cognition theme; % = portion of total mentions for each SA subgroup that met that theme criteria, e.g. ‘50%’ would mean that half of all the trauma cognitions documented for an SA subgroup were on that content theme. Content themes are not mutually exclusive.

Table 4. Logistic, Poisson and negative binomial regression analyses comparing sexual assault groups on post-trauma psychiatric symptoms.

Symptom	Total N(N = 74)		DFSA-I(n = 26)		DFSA-V(n = 16)		NDFSA(n = 32)		Overall group effect			Pairwise group comparisons
												DFSA-I vs. DFSA-V		DFSA-I vs. NDFSA		DFSA-V vs. NDFSA
	n	%	n	%	n	%	n	%	x^2(2)	p^a	V^b	OR	p	OR	p	OR	p
												(95% CI)		(95% CI)		(95% CI)
PTSD symptoms
Re-experiencing
Memories	55	74.3	20	76.9	10	62.5	25	78.1	1.43	.65	.14	2.00	.32	0.93	.91	0.47	.26
												(.51–7.81)		(.27–3.22)		(.13–1.74)
Nightmares	44	59.5	12	46.2	9	56.3	23	71.9	4.08	.50	.23	0.67	.53	0.34	.05	0.50	.28
												(.19–2.33)		(.11–1.00)		(.14–1.76)
Flashbacks	29	39.2	9	34.6	5	31.3	15	46.9	1.45	.66	.14	1.17	.82	0.60	.35	0.52	.30
												(.31–4.41)		(.21–1.74)		(.15–1.83)
Emotional distress	51	68.9	17	65.4	10	62.5	24	75.0	1.02	.63	.12	1.13	.85	0.63	.43	0.56	.37
												(.31–4.14)		(.20–1.96)		(.15–2.02)
Physical distress	30	41.1	11	42.3	3	18.8	16	51.6	5.06	.40	.25	3.18	.13	0.69	.48	0.22	.04
												(.73–13.92)		(.24–1.96)		(.05–.91)
Avoidance
Cognitive	36	49.3	12	46.2	6	40.0	18	56.3	1.25	.64	.13	1.29	.70	0.67	.44	0.52	.30
												(.35–4.67)		(.24–1.89)		(.15–1.80)
Behavioural	56	75.7	21	80.8	9	56.3	26	81.3	3.84	.50	.24	3.27	.09	0.97	.96	0.30	.07
												(.82–13.0)		(.26–3.62)		(.08–1.12)
Numbing
Amnesia	44	60.3	21	80.8	10	62.5	13	41.9	9.30	.10	.35	2.52	.20	5.82	<01	2.31	.19
												(.62–10.28)		(1.74–19.47)		(.67–7.96)
Loss of interest	43	58.1	12	46.2	10	62.5	21	65.6	2.39	.58	.18	.51	.31	0.45	.14	0.87	.83
												(.14–1.84)		(.16–1.30)		(.25–3.04)
Detachment	55	74.3	21	80.8	9	56.3	55	78.1	3.30	.48	.22	3.27	.09	1.18	.80	0.36	.12
												(.82–13.09)		(.33–4.26)		(.10–1.32)
Emotional numbing	15	20.3	4	15.4	5	31.3	6	18.8	1.53	.70	.15	0.40	.23	0.79	.74	1.97	.34
												(.09–1.79)		(.20–3.15)		(.50–7.83)
Foreshortened future	8	11.0	4	15.4	2	12.5	2	6.5	1.25	.64	.13	1.27	.80	2.64	.29	2.07	.49
												(.21–7.89)		(.44–15.72)		(.26–16.27)
Hyper-arousal
Insomnia	57	78.1	16	61.5	13	81.3	28	90.3	6.98	.20	.31	0.37	.19	0.17	.02	0.46	.38
												(.08–1.63)		(.04–.72)		(.08–2.62)
Irritability	58	78.4	21	80.8	12	75.0	25	78.1	0.20	.91	.05	1.40	.66	1.18	.80	0.84	.81
												(.31–6.24)		(.33–4.23)		(.21–3.43)
Concentration	57	77.0	21	80.8	10	62.5	26	81.3	2.25	.53	.18	2.52	.20	0.97	.96	0.39	.16
												(.62–10.28)		(.26–3.62)		(.10–1.48)
Hypervigilant	57	78.1	19	73.1	10	66.7	28	87.5	3.28	.48	.21	1.36	.66	0.39	.17	0.29	.10
												(.34–5.39)		(.10–1.51)		(.06–1.28)
Hyperstartle	42	57.5	12	46.2	9	60.0	21	65.6	2.27	.53	.18	0.57	.39	0.45	.14	0.79	.71
												(.16–2.07)		(.16–1.30)		(.22–2.78)
Dissociation
Dazed	15	20.3	6	23.1	1	6.3	8	25.0	2.85	.53	.16	4.20	.21	0.86	.81	0.21	.16
												(.45–38.84)		(.26–2.91)		(.02–1.82)
Derealization	33	44.6	10	38.5	7	43.8	16	50.0	1.01	.63	.13	0.80	.73	0.59	.32	0.73	.61
												(.23–2.85)		(.20–1.69)		(.22–2.45)
Depersonalization	30	40.5	10	38.5	1	6.3	19	59.4	13.65	.02	.32	8.75	.05	0.43	.12	0.05	<01
												(.99–77.19)		(.15–1.23)		(.01–.42)
Depression Symptoms
Depressed mood	59	80.8	18	72.0	14	87.5	27	84.4	1.92	.57	.16	0.37	.25	0.48	.26	1.30	.77
												(.07–2.05)		(.13–1.74)		(.22–7.55)
Anhedonia	45	61.6	11	44.0	12	75.0	22	68.8	5.16	.24	.27	0.26	.06	0.36	.06	1.36	.65
												(.07–1.04)		(.12–1.06)		(.35–5.29)
Appetite	42	58.3	10	40.0	10	66.7	22	68.8	5.31	.24	.27	0.33	.11	0.30	.03	0.91	.89
												(.09–1.27)		(.10–.91)		(.25–3.36)
Insomnia	58	80.6	16	66.7	14	87.5	28	87.5	4.21	.27	.25	0.29	.15	0.29	.07	1.00	.99
												(.05–1.58)		(.07–1.10)		(.16–6.14)
Fatigue	44	60.3	12	48.0	7	43.8	25	78.1	7.93	.18	.32	1.19	.79	0.26	.02	0.22	.02
												(.34–4.19)		(.08–.82)		(.06–.80)
Concentration	52	72.2	19	76.0	10	62.5	23	74.2	.95	.80	.12	1.90	.36	1.10	.88	0.58	.41
												(.49–7.45)		(.33–3.73)		(.16–2.11)
Psychomotor	20	27.8	4	16.0	5	31.3	11	35.5	2.90	.41	.20	0.42	.26	0.35	.11	0.83	.77
												(.09–1.89)		(.10–1.27)		(.23–3.00)
Guilt	39	54.2	13	52.0	8	50.0	18	58.1	0.35	.84	.07	1.08	.90	0.78	.65	0.72	.60
												(.31–3.80)		(.27–2.26)		(.22–2.43)
Death thoughts	17	23.6	5	20.0	5	31.3	7	22.6	0.69	.80	.10	0.55	.42	0.86	.82	1.56	.52
												(.13–2.33)		(.24–3.12)		(.40–6.02)
Symptom counts	M	SD	M	SD	M	SD	M	SD	x^2(2)	p		z	p	z	p	z	p
# PTSD	10.0	3.5	9.7	3.5	8.9	3.7	10.7	3.3	3.76	.15		0.88	.38	−1.13	.26	−1.86	.06
# Re-experiencing	2.8	1.5	2.7	1.6	2.3	1.5	3.2	1.4	3.54	.17		0.68	.50	−1.24	.21	−1.73	.08
# Avoidance	1.3	0.7	1.3	0.8	0.9	0.8	1.4	0.7	1.71	.42		0.96	.34	−0.35	.73	−1.26	.21
# Numbing	2.3	1.1	2.4	0.9	2.3	1.2	2.1	1.1	0.55	.76		0.28	.78	0.74	.46	0.35	.73
# Hyper-arousal	3.7	1.3	3.4	1.3	3.4	1.4	4.0	1.2	1.67	.43		0.04	.97	−1.13	.26	−0.98	.33
# Dissociation	1.1	1.1	1.0	1.1	0.5	0.6	1.4	1.1	7.23	.03		1.55	.12	−1.22	.22	−2.42	.02
# Depression	5.2	2.3	4.3	2.5	5.3	2.39	5.7	2.0	5.56	.06		−1.43	.15	−2.31	.02	−0.56	.57

Note: DFSA-I = drug-facilitated sexual assault, involuntary ingestion; DFSA-V = drug-facilitated sexual assault, voluntary ingestion; NDFSA = non-drug-facilitated sexual assault.

^a Benjamini-Hochberg adjusted p-values were used to account for multiple tests involving individual PTSD and depression symptoms.

^b Cramer’s V.

Table 5. Logistic, Poisson, and negative binomial regression analyses comparing assault survivors with impaired and intact trauma memory on post-trauma symptoms.

Symptom	Impaired trauma memory (n = 18)		Intact trauma memory (n = 56)		Group effect			Impaired vs. intact trauma memory
	n	%	n	%	x^2(1)	p^a	V^b	OR	95% CI
PTSD symptoms
Re-experiencing
Memories	11	61.1	44	78.6	2.06	.43	.17	0.43	.14–1.34
Nightmares	8	44.4	36	64.3	2.19	.43	.17	0.44	.15–1.31
Flashbacks	5	27.8	24	42.9	1.34	.38	.13	0.51	.16–1.64
Emotional distress	10	55.6	41	73.2	1.91	.40	.16	0.46	.15–1.38
Physical distress	6	33.3	24	42.9	0.60	.59	.11	0.65	.21–1.97
Avoidance
Cognitive	9	50.0	27	48.2	0.00	.95	.07	1.04	.36–3.01
Behavioural	12	66.7	44	78.6	1.00	.46	.12	0.55	.17–1.76
Numbing
Amnesia	13	72.2	31	55.4	2.56	.44	.27	2.62	.76–9.04
Loss of interest	8	44.4	35	62.5	1.81	.36	.16	0.48	.16–1.41
Detachment	9	50.0	46	82.1	6.80	.06	.32	0.22	.07–.69
Emotionally numb	4	22.2	11	19.6	0.06	.85	.03	1.17	.32–4.26
Foreshortened future	4	22.2	4	7.1	2.73	.44	.22	3.64	.81–16.44
Hyper-arousal
Insomnia	12	66.7	45	80.4	1.71	.35	.17	0.44	.13–1.47
Irritability	13	72.2	45	80.4	0.51	.59	.08	0.64	.19–2.16
Concentration	13	72.2	44	78.6	0.30	.68	.06	0.71	.21–2.39
Hypervigilant	8	44.4	49	87.5	11.07	.02	.45	0.13	.04–.44
Hyperstartle	5	27.8	37	66.1	7.20	.06	.37	0.21	.07–.70
Dissociation
Dazed	2	11.1	13	23.2	1.52	.37	.17	0.39	.08–1.95
Derealization	9	50.0	24	42.9	0.22	.71	.09	1.29	.45–3.75
Depersonalization	5	27.8	25	44.6	1.81	.35	.17	0.46	.15–1.47
Depression symptoms
Depressed mood	12	66.7	47	83.9	2.83	.23	.22	0.34	.10–1.17
Anhedonia	6	33.3	39	69.6	7.96	.04	.34	0.21	.07–.64
Appetite change	9	50.0	33	58.9	0.68	.57	.14	0.64	.22–1.86
Insomnia	12	66.7	46	82.1	2.72	.23	.22	0.35	.10–1.20
Fatigue	7	38.4	37	66.1	4.49	.14	.26	0.31	.10–.93
Concentration	12	66.7	40	71.4	0.03	.86	.10	0.90	.27–2.99
Psychomotor	6	33.3	14	25.0	0.61	.57	.14	1.60	.50–5.12
Guilt	11	61.1	28	50.0	1.01	.56	.15	1.77	.57–5.45
Death thoughts	5	27.8	12	21.4	0.40	.60	.12	1.49	.44–5.08
Symptom counts	M	SD	M	SD		p		z
# PTSD	8.33	4.24	10.48	3.10	6.57	.01		−2.51
# Re-experiencing	2.22	1.80	3.02	1.33	3.22	.07		−1.74
# Avoidance	1.17	0.86	1.27	0.71	0.12	.72		−0.35
# Numbing	2.11	1.02	2.27	1.09	0.15	.70		−0.39
# Hyper-arousal	2.82	1.63	3.93	1.04	4.61	.03		−2.07
# Dissociation	0.89	0.96	1.11	1.08	0.66	.42		−0.79
# Depression	4.44	2.94	5.38	2.08	2.39	.12		−1.52

^a Benjamini-Hochberg adjusted p-values were used to account for multiple tests involving individual PTSD and depression symptoms.

^b Cramer’s V.

Du Mont, J., Macdonald, S., Rotbard, N., Asllani, E., Bainbridge, D., & Cohen, M. M. (2009). Factors associated with suspected drug-facilitated sexual assault. Canadian Medical Association Journal, 180(5), 513–519. doi:10.1503/cmaj.080570

 PubMed Web of Science ®Google Scholar

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.