ADHD: More than half of women with ADHD have experienced Sexual Victimization

ADHD and Sexual Victimization: Adults with ADHD histories were more likely to report any form of sexual victimization (53.6%) than adults in the control group. 15% of all women with ADHD have experienced ‘unwanted sexual touching’ (vs. 9% of women without ADHD), and 9% of women with ADHD have been raped (vs. 4% of women without ADHD). This means that women with ADHD have 41% higher risk of experiencing ‘’unwanted sexual touching” and 85% higher risk of being raped. Why!?

Abstract

Objective: Adults with ADHD are often victims of psychological and physical violence by romantic partners, but less is known regarding whether ADHD is associated with sexual assault victimization.

Method: Adults with (n = 97) and without childhood histories of ADHD (n = 121) rated their experiences with sexual assault victimization and additional risk factors (i.e., alcohol abuse, illicit drug use, and experiencing child abuse).

Results: Adults with ADHD histories were more likely to report being victims of sexual assault, especially attempted rape or rape, than adults without ADHD histories. The rate of rape victimization was not greater for adults with ADHD histories and persistent symptoms or additional risk factors.

Conclusion: Research is needed to investigate potential mechanisms explaining the link between ADHD and sexual victimization. Clinicians seeking to prevent at-risk populations from becoming victims, or to provide services for victims, should consider screening adults for ADHD histories.

Wymbs et al. (2020)

Introduction

In females, ASD was associated with an almost threefolded increased risk of coercive sexual victimization, and ADHD with a doubled risk. In males, the risk associated with ASD and ADHD was of the same magnitude but not significant.

Gotby et al. (2018)

A frequent misconception is that the most common form of sexual victimization is “blitz rape,” where strangers jump out of bushes to violently attack a victim. The reality is that most sexual assaults take place among acquaintances and tend to be less violent than the typical stranger rape. (Wymbs et al., 2020).

Given this, frequently, the situations surrounding sexual assaults may not initially be that different from prototypical social situations, and risk cues are not as obvious as they are in stranger rapes (Nurius & Norris, 1996).

Thus, during this phase, it is very important that individuals attend to what often are more subtle cues that a situation is moving from that of a social to a dangerous one. (Wymbs et al., 2020).

In the second phase, an individual does a cost-benefit analysis of the various response options that are available and the potential response outcomes if one responds in a particular way (Vitek et al., 2018).

Although it has been well-documented that more assertive and active responding is more likely to lead to assault avoidance than passive strategies (Gidycz & Dardis, 2014), during this phase, there are various barriers to responding assertively (Vitek et al., 2018).

Polyvictimization is defined as exposure to multiple forms of abuse, victimization, or violence including, but not limited to, conventional crime, child maltreatment, peer and sibling victimization, sexual assault, and witnessing and indirect victimization

Hellström et al. (2019)

Background

Sexual violence is a serious public health problem affecting millions of people in the United States every year (Smith et al., 2018). One in five women are victims of attempted rape or rape, one in six are victims of sexual coercion (i.e., unwanted sexual penetration after being pressured in a non-physical way), and one in three are victims of unwanted sexual contact (i.e., unwanted sexual experiences involving touch, but not sexual penetration; Smith et al., 2018).

Sexual assault experiences are less frequent for men, but far from insignificant (i.e., 2.6% victims of attempted rape or rape, 9.6% victims of sexual coercion, and 17.9% victims of unwanted sexual contact; Smith et al., 2018).

Experiencing sexual assault has a deleterious impact on the daily functioning of victims, including negative effects on their mental and physical health (e.g., posttraumatic stress disorder symptoms and chronic pain; Black et al., 2011) and on their problem drinking and other health risk behaviors (e.g., Turchik & Hassija, 2014).

Given these common sequelae of sexual victimization, victims often endure additional costly outcomes, including missing days of work or school and paying for health care or legal services (Black et al., 2011).

Compared to individuals without ADHD, those with ADHD I) are more likely to become parents while being teenagers, II) are less likely to become parents in general, III) are more likely to have many children (three or more for males and four or more for females) if they do become parents, and IV) have fewer children on average (only males).

Østergaard et al., (2017)

ADHD History and Sexual Assault Victimization

We found that 40.4% (n = 88) of our participants reported experiencing behaviors consistent with at least one form of sexual assault victimization since the age of 14 years, including 6.0% (n = 13) whose most significant event was being a victim of unwanted sexual contact, 8.7% (n = 19) whose most significant event was being a victim of attempted sexual coercion or sexual coercion, and 25.7% (n = 56) whose most significant event was being a victim of attempted rape or rape. (Wymbs et al., 2020).

Adults with ADHD histories were more likely to report any form of sexual victimization (53.6%) than adults in the control group (29.8%; χ2 = 12.73, p < .01; OR = 2.73). (Wymbs et al., 2020).

Rates of sexual victimization were similar for adults in the ADHD-Persist and -Desist groups (53.8% vs. 53.4%). (Wymbs et al., 2020).

Additional tests indicated no between-group difference in rates of unwanted sexual contact or attempted sexual coercion or sexual coercion, but did indicate that adults with ADHD histories were more likely to report being victims of attempted rape or rape (38.95%) than adults in the control group (15.70%; χ2 = 14.97, p < .01; OR = 3.31). (Wymbs et al., 2020).

Again, there was no difference in rates of rape victimization for the ADHD-Persist and -Desist groups (35.9% vs. 39.7%). (Wymbs et al., 2020).

Acknowledging these results, subsequent tests were only conducted considering childhood ADHD status (and not symptom persistence) with (attempted) rape victimization. (Wymbs et al., 2020).

Findings

Such barriers include emotional barriers such as self-blame or sadness, which can impede active resisting, whereas feelings of self-confidence or efficacy can lead to more active and effective responding. (Wymbs et al., 2020).

Based on the cognitive ecological model, one can speculate that individuals with ADHD may be prone to sexual victimization, owing to the ways in which their symptoms create risk. (Wymbs et al., 2020).

One of the hallmark symptom domains of ADHD is difficulty paying attention. Many symptoms of inattention (e.g., fail to give close attention to details, make careless mistakes, not seeming to listen when being spoken to directly, and easily distracted by extraneous stimuli) would appear prime candidates for reducing the likelihood that important social cues (which can be quite subtle in the cases of sexual assault) are received, such as clues that someone may intend to harm them. (Wymbs et al., 2020).

Missing these context cues no doubt impairs one’s ability to assess for risk in social situations and taking action to reduce this risk. (Wymbs et al., 2020).

Thus, within the context of the cognitive ecological model of sexual victimization, ADHD would seem to be a prime risk variable for sexual victimization. (Wymbs et al., 2020).

Interestingly, like Snyder (2015), we found that ADHD was uniquely associated with attempted rape or rape victimization even when accounting for common risk factors (i.e., sex, alcohol abuse, illicit drug use, or child abuse). (Wymbs et al., 2020).

In fact, the only additional risk factor that was uniquely associated with attempted rape or rape victimization was sex, with women being at greater risk of attempted rape or rape victimization than men. (Wymbs et al., 2020).

Women are routinely found to be victims of sexual assault more often than men in the literature (e.g., Smith et al., 2018).

Thus, being diagnosed with ADHD as a child was uniquely associated with experiencing sexual assault victimization; not just an indicator of adults who were victims owing to other risk factors. (Wymbs et al., 2020).

In the event these findings are replicated, it would suggest that when treating emerging adults who have ADHD, it might be particularly useful to highlight the characteristics of potential perpetrators in an attempt to prevent future sexual assault victimization. (Wymbs et al., 2020).

At the same time, although those with ADHD and without ADHD did not differ on most of the resistance strategies, it is noteworthy that those with ADHD utilized crying more in response to the attack than those without ADHD. (Wymbs et al., 2020).

Dangerous consequence of ADHD symptoms

Given that crying, a passive strategy, is one of the least effective methods for avoiding a sexual assault (Gidycz & Dardis, 2014), it is important to address barriers that those with ADHD may experience to responding more assertively. (Wymbs et al., 2020).

Three studies have also evaluated ADHD as a risk factor for sexual victimization, which can occur within and outside of romantic relationships. (Wymbs et al., 2020).

White and Buehler (2012) showed that college women reporting elevated symptoms of ADHD in childhood were more likely to report sexual victimization after the age of 13 years than women with low ADHD symptoms. (Wymbs et al., 2020).

Snyder (2015) reported that college women reporting prior diagnoses of ADHD were significantly more likely to experience any type of sexual victimization (16.5%) than women without ADHD histories (10.3%). (Wymbs et al., 2020).

More specifically, nearly 15% of female students with ADHD histories reported they experienced unwanted sexual touching compared with 9% of female students without ADHD histories (p < .05, odds ratio [OR] = 1.41), and 9% of female students with ADHD histories reported they had been raped compared with 4% of female students without ADHD histories (p < .05, OR = 1.85). (Wymbs et al., 2020).

References

Ohlsson Gotby, V., Lichtenstein, P., Långström, N., & Pettersson, E. (2018). Childhood neurodevelopmental disorders and risk of coercive sexual victimization in childhood and adolescence – a population-based prospective twin study. Journal of child psychology and psychiatry, and allied disciplines, 59(9), 957–965. https://doi.org/10.1111/jcpp.12884

Hellström L. (2019). A Systematic Review of Polyvictimization among Children with Attention Deficit Hyperactivity or Autism Spectrum Disorder. International journal of environmental research and public health, 16(13), 2280. https://doi.org/10.3390/ijerph16132280

Østergaard, S. D., Dalsgaard, S., Faraone, S. V., Munk-Olsen, T., & Laursen, T. M. (2017). Teenage Parenthood and Birth Rates for Individuals With and Without Attention-Deficit/Hyperactivity Disorder: A Nationwide Cohort Study. Journal of the American Academy of Child and Adolescent Psychiatry, 56(7), 578–584.e3. https://doi.org/10.1016/j.jaac.2017.05.003

Wymbs, B. T., & Gidycz, C. A. (2020). Examining Link Between Childhood ADHD and Sexual Assault Victimization. Journal of attention disorders, 1087054720923750. Advance online publication. https://doi.org/10.1177/1087054720923750