A Review of the Role of Stigma Among Female Survivors of CSA, SA, and IPV As a Barrier to Attaining Effective Services

Background and Purpose: Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others, such as family members, friends, and formal service providers. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma, which includes victim-blaming social reactions from others as well as self-blame, shame, and anticipatory stigma (e.g., the expectation that they will be blamed). These elements of stigma play a key role in survivors’ recovery as well as their risk of revictimization, and are a critical barrier to help seeking and attainment. In this review, we synthesize recent CSA, SA, and IPV research (N = 122 peer-reviewed journal articles) on female survivors’ self-blame, shame, internalized stigma, and anticipatory stigma, as well as negative social reactions in response to survivors’ disclosure, as a barrier to attaining effective services.

Methods: In addition to conducting searches via Medline, PsycINFO, Scopus, and Social Sciences Citation Index, we reviewed the reference lists of previously identified stigma-related studies as well as each issue of ten leading violence journals. Articles were eligible for inclusion if they reported on studies that included CSA, SA, and/or IPV plus any aspect of stigma related to victimization (self-blame, shame, internalized stigma, anticipatory stigma, and/or negative social reactions involving victim-blaming or stigmatizing), focused on the point of view of female survivors, were published in a peer-reviewed journal between January 2000 and September 2015, and were conducted in the United States. We initially identified 691 articles; after screening for duplicates and inclusion criteria, our search yielded 14 CSA articles (one qualitative, 13 quantitative), 58 SA articles (six qualitative, five mixed methods, 47 quantitative), 37 IPV articles (19 qualitative, three mixed methods, 15 quantitative), and 13 co-occurring CSA, SA, or IPV articles (all 13 quantitative), for a total of 122. 

Results: Self-blame, shame, and anticipatory stigma are critical barriers to disclosure and help seeking; particularly among SA and IPV survivors, stigmatizing social reactions such as victim-blaming are common among formal service providers. Self-blame, shame, and stigmatizing social reactions are linked to poor outcomes such as PTSD, depression, and maladaptive coping; longitudinal studies indicate that non-disclosure because of anticipatory stigma, along with stigmatizing social reactions, predict sexual revictimization over time. Finally, there is a reciprocal, bi-directional relationship over time between self-blame and negative social reactions, and prior CSA seems to exacerbate self-blame and stigma among SA and IPV survivors.

Implications: Survivor-centered and trauma-informed practice and policy must incorporate an understanding of the importance of stigma in shaping survivors’ recovery, revictimization risk, and help seeking and attainment processes. Formal service providers such as law enforcement, medical personnel, and social service agencies must be trained regarding the role of victim-blaming reactions in worsening survivors’ self-blame, shame, and psychological outcomes such as PTSD, so they do not revictimize survivors. Interventions designed to ameliorate the negative sequelae of CSA, SA, and IPV should address both internal and external stigma.