The Psychosocial Consequences of Sexual Violence Stigma: A Scoping Review

Studies Using Samples of Stigmatizers

In our sample, 14 articles captured measures of stigmatizing attitudes held by potential stigmatizers. These studies sampled from the general population (n = 3) as well as specific groups, including college students (n = 7), mental health providers (n = 2), medical students (n = 1), and victim service providers (n = 1). Two studies sampled from multiple groups (e.g., college students and medical students). One study of structural SV stigma sampled from newspaper headlines describing news stories about survivors of IPV (Leung, 2019). Most studies that surveyed participants sampled both male and female participants (n = 12). One study only recruited male participants (Gruenfeld et al., 2017). Just two studies reported that they also included transgender and non-binary participants (Delker et al., 2020; Schomerus et al., 2021).

The majority of these studies were quantitative (n = 10) and used survey (n = 9) or experimental (n = 2) designs. Four studies were qualitative. Most of the quantitative articles presented participants with either vignettes (i.e., description of an incident of SV; e.g., Erickson et al., 2017) or hypothetical scenarios (i.e., “What would you think if your child wanted to marry a survivor of sexual abuse?”; e.g., Kandemir et al., 2012) designed to capture potentially stigmatizing attitudes toward survivors of SV. Most of these studies (n = 11) focused on attitudes/behavioral intentions toward a single type of SV rather than differences in attitudes across SV types. Two studies referred to SV generally, without identifying a specific type of SV.

All 10 quantitative studies found evidence of stigma toward survivors of multiple types of SV (i.e., rape, SA, IPV, CSA, and image-based sexual abuse) across a range of stigma-related outcomes, including desire for social distance (Kandemir et al., 2012; Schomerus et al., 2021; Weidner & Griffitt, 1983), victim blaming attitudes (Arnocky & Vaillancourt, 2014; Erickson et al., 2017), perceived dangerousness (Kandemir et al., 2012), negative attitudes toward survivors after disclosure (i.e., less “likable”; Delker et al., 2020; Hall, 2012), as well as general indices of comfort/discomfort around survivors (Tomlin, 1991). Negative stereotypes observed in these articles ranged from the association of SV victimization with negative qualities such as being a liar, being weak, or being unattractive (Arnocky & Vaillancourt, 2014) to perceptions of “spoiled innocence” (Böhm, 2017) and reduced likability (Delker et al., 2020).

One investigation by Delker et al. (2020), which recruited four samples of U.S. adults (N = 1,872), asked participants to evaluate vignettes containing trauma narratives of survivors of six different types of traumatic events (natural disaster, car accident, life-threatening illness, traumatic loss, CSA, and SA) and rate how difficult those stories were to tell, and how likable they found the storyteller to be. Across samples, researchers found that, even when the vignettes were manipulated to give the trauma narrative a redemptive ending, SV trauma stories were perceived as more difficult to tell, and their narrators were seen as less likable, as compared to other traumatic events (Delker et al., 2020). This investigation suggests that stigma is attached to SV specifically, as opposed to trauma more broadly.

Further, a quantitative investigation by Nikolova et al. (2021) found that survivors of IPV who were still living with their abusers were less likely to receive waivers for financial support through the Family Violence Option than those who were no longer living with abusers, even after accounting for type and severity of IPV, despite the reality that many survivors are unable to leave abusers due to lack of financial resources.

Additionally, three qualitative investigations interviewed healthcare providers about their perceptions of stigma experienced by survivors of SV both within and outside of the healthcare system; providers reported that SV stigma acts as a key barrier to both disclosure and help-seeking among survivors of CSA, particularly men (Böhm, 2017; Emezue & Udmuangpia, 2022; Gruenfeld et al., 2017). One qualitative investigation performed a discourse analysis on media representations of IPV in Hong Kong newspapers, identifying themes of labeling, victim-blaming, and stereotyping toward those who have experienced IPV (Leung, 2019).

Studies Using Samples of SV Survivors

In our sample, 20 articles measured the experiences and perceptions of SV stigma among survivors. Of these studies, 8 sampled both male and female participants, 1 study sampled only male participants, and 11 sampled only female participants. No studies reported that they recruited participants with transgender and/or non-binary identities.

Most of these studies were qualitative (n = 11), six were quantitative, and three employed mixed-method designs. Most studies captured perceptions or experiences of SV stigma at the individual or interpersonal level (or both); only one study captured structural SV stigma. All 20 articles that surveyed survivors of SV about their experiences and perceptions of SV stigma found evidence of SV stigma.

Individual Level

Studies identified by our search captured several forms of SV stigma at the individual level, including internalized stigma (i.e., the degree to which survivors have internalized stigmatizing attitudes about people who have experienced SV; Crowe et al., 2021; Eckstein, 2016); anticipated stigma (e.g., expecting to be discriminated against due to an experience of SV; Crowe et al., 2021; Manrai et al., 2021; Murray et al, 2018b); and disclosure concerns (e.g., worrying about a negative response to the disclosure of an experience of SV; Shaked et al., 2021).

Interpersonal Level

Studies in our sample found evidence of stigma-related processes at the interpersonal level, including discrimination (Crowe & Murray, 2015; Jewkes et al., 2021); negative responses to disclosure (Thurston et al., 2016); status loss (Crowe & Murray, 2015); and labeling (Crowe & Murray, 2015). Many studies specified from whom SV survivors experienced interpersonal stigma. Results were notably diverse, with survivors reporting experiences of SV stigma from recipients of disclosures (Manrai et al., 2021), people in their personal lives such as friends and family (Buchbinder & Karayanni, 2015; Murray et al., 2016; Thurston et al, 2016), as well as romantic partners (particularly in the case of IPV; Bernett et al., 2016; Crowe et al., 2021; Murray et al., 2018c). SV survivors also reported experiencing stigma from formal supports such as law enforcement, the legal system, medical providers, mental health providers, religious institutions, and victim services providers (Crowe & Murray, 2015).

Structural Level

One investigation by Barnett et al. (2016) measured perceived structural stigma by conducting focus groups of women survivors of IPV in Kenya and inquiring about certain laws, policies, and community attitudes systematically disadvantage survivors of IPV. They found that survivors encountered stigma culturally, in the form of victim-blaming attitudes, as well as structurally, in the form of legal systems that would ignore or undermine survivors’ reports of spousal rape and violence (Barnett et al., 2016). Three additional studies provided evidence of structural SV stigma and are discussed in the next section because they explicitly linked these measures to psychosocial outcomes.

Sample Characteristics

All studies recruited samples of survivors of SV, including survivors of CSA (n = 13), IPV (n = 7), rape (n = 8), sexual assualt (n = 7), and SV broadly (n = 3). Six articles evaluated multiple forms of SV within the same study. Most studies in our sample recruited exclusively female survivors (n = 18). Eleven studies recruited both male and female participants, two of which also recruited non-binary and transgender participants. Among the 11 studies that recruited both male and female participants, males made up an average of 38.8% (SD = 11.41) of survivors in the sample. Of the two studies that reported on the percentage of non-cisgender participants (Mostajabian et al, 2019; Schröder et al., 2021), transgender, and non-binary participants made up less than 3% of each sample.

Measures

A range of measurement approaches were used to operationalize SV stigma among those exposed to SV. A handful of studies modified scales from other stigma literatures to assess SV stigma. For example, Jewkes et al. (2021) modified the South African AIDS Stigma Scale, Overstreet et al. (2017, 2019) and Quinn et al. (2014) modified Link’s Devaluation-Discrimination Scale for Mental Illness, and Eckstein (2016) modified the 22-item Berger HIV Stigma Scale. The remaining studies largely relied on researcher-generated scales designed for use in a specific investigation, which were typically comprised of multiple subscales (commonly self-blame, shame, internalized stigma, anticipated stigma, disclosure, and discrimination). Other studies used existing scales to quantify stigma-related constructs, such as abuse-related self-blame (Feiring et al., 2007, 2009, 2013), felt stigma (Wachter et al., 2018), social reactions (Hakimi et al., 2018), and help-seeking concerns (Andresen & Blais, 2019; Mlyakado & Li, 2021).

Individual and Interpersonal Level

In terms of stigma level, the majority of articles measured SV stigma at the individual and/or the interpersonal levels (n = 25). At the individual level, internalized stigma was associated with depression symptoms (Overstreet et al., 2017), psychological distress (Quinn et al., 2014), reduced help-seeking (Mlyakado et al., 2021), poor psychological adjustment (Coffey et al., 1996), and disrupted identity development (Lanctota et al., 2021). Further, internalized stigma fully mediated the relationship between victim blame and PTSD symptoms (Schröder et al., 2021). Anticipated stigma was associated with increased psychological distress (Andresen & Blais, 2019; Miller et al., 2011; Mostajabian et al., 2019; Quinn et al., 2014) as well as sexual revictimization (Miller et al., 2011) and poor psychological adjustment (Coffey et al., 1996). In longitudinal work, stigma-related shame and self-blame were prospectively associated with subsequent delinquent behaviors (Feiring et al., 2007), internalizing symptoms (Feiring et al., 2009), dating aggression (Feiring et al, 2013), and more severe symptoms of PTSD (Simon et al., 2017).

The literature captured two individual-level constructs related to disclosure: disclosure concerns—or the degree to which a survivor is worried about a negative response to their potential disclosure (e.g., Eckstein, 2016; Gibson & Leitenberg, 2001; Miller et al., 2011; Quinn et al., 2014)—as well as the actual behavioral act of disclosure (i.e., whether or not someone has told one other person in their network about their experience of SV; Andresen & Blais, 2019; Deitz et al., 2015; Hakimi et al., 2018; Maticka-Tyndale et al., 2020). Disclosure concerns were associated with reduced behavioral disclosure, increased psychological distress, and sexual revictimization (Miller et al., 2011; Quinn et al., 2014). Internalized stigma and anticipated stigma were associated with reduced behavioral disclosure (Andresen & Blais, 2019; Overstreet et al., 2017). Two investigations identified potential moderators of the relationship between internalized stigma and behavioral disclosure, including event centrality (Overstreet et al., 2017) and challenges to stigma (e.g., positive outreach by a bystander; Maticka-Tyndale et al., 2020).

At the interpersonal level, discrimination (e.g., differential treatment because a survivor of SV is deemed “tainted” by the experience) was associated with symptoms of anxiety, depression, and PTSD (Murray et al., 2021; Overstreet et al., 2019; Wachter et al., 2018). Overstreet et al. (2019) found that when survivors of SV were met with stigmatizing reactions to their disclosure characterized by discrimination, separation (i.e., social distance), and/or labeling, they experienced more severe symptoms of depression and were more likely to employ avoidant methods of coping.

Interpersonal forms of SV stigma have also been examined in relation to help-seeking, defined as seeking formal or informal support to cope with the consequences of SV exposure. Help-seeking is distinct from disclosure, which refers to telling another person about an experience of SV, without necessarily seeking help (Muuo et al., 2020). Evidence that interpersonal-level SV stigma is a barrier to help-seeking is mixed, with some studies finding a positive association (Muuo et al., 2020) and others not (Mlyakado & Li, 2021). However, the stigma around receiving help following SV (i.e., the degree to which a person views seeking help to cope with an experience of SV as a sign of personal weakness or inadequacy) moderated the relationship between adolescents’ attitudes toward help-seeking and their actual intention to seek help (Mlyakado & Li, 2021).

Finally, one investigation by Murray et al. (2018c) evaluated SV stigma at the interpersonal level (i.e., felt stigma) as a moderator of treatment efficacy among a sample of survivors of SV in the Democratic Republic of Congo who underwent treatment with Cognitive Processing Therapy (CPT). Participants who received CPT experienced moderate decreases in felt stigma over the course of treatment, although this effect did not remain at the 6-month follow-up (Murray et al., 2018c). Investigators did not observe a moderating effect of SV stigma on treatment effectiveness as determined by mental health symptoms or functional impairment.

Structural Level

Only three studies measured stigma at the structural level and connected structural SV stigma to some form of psychosocial outcome. Among these studies, two used subjective self-report measures to quantify perceived structural SV stigma (Deitz et al., 2015; Maticka-Tyndale et al., 2020), and two used objective measures in the form of aggregated community attitudes (Dworkin et al., 2017) or institutional practices (Nikolova et al., 2021). Perceived structural SV stigma was associated with reductions in both formal and informal disclosure (Maticka-Tyndale et al., 2020). Deitz et al. (2015) additionally found that perceived structural SV stigma was associated with PTSD symptoms; however, this finding did not hold after controlling for self-blame and social reactions to disclosure. One explanation for these findings may be that self-blame and social reactions mediate the relationship between perceived structural SV stigma and PTSD symptoms, but authors did not test mediation.

In terms of objective measures, only one study directly linked objective structural-level measures of SV stigma to health outcomes among survivors. This study was conducted by Dworkin et al. (2017), who administered a rape myth acceptance (RMA) measure to 3,080 students across 25 high schools. Students who experienced SA were at greater risk for depressed mood when there was high RMA among students in their grade cohort, suggesting that exposure to a high SV stigma environment can hinder recovery following the experience of SV.

Strengths of the Current Review

Like Kennedy and Prock (2018), we find that exposure to SV stigma is associated with a range of adverse psychosocial and health outcomes. However, our review expands on their previous review in two key ways. First, whereas Kennedy and Prock (2018) only included articles focusing on the perspectives of cisgender women, our search included cisgender male, transgender, and non-binary survivors of SV, which is a critical contribution in light of nationally representative data indicating that men and women report similar rates of non-consensual sex across a 12-month period (Stemple & Meyer, 2014) and that transgender people are at substantially greater risk for IPV and SA than cisgender people (Peitzmeier et al., 2020; Ybarra et al., 2022). Second, although Kennedy and Prock (2018) drew on some constructs from the stigma literature (i.e., anticipated stigma, internalized stigma, and negative social reactions), they did not include other relevant and well-established stigma constructs, including disclosure concerns (Chaudoir & Quinn, 2010) and structural stigma (e.g., Hatzenbuehler & Pachankis, 2016), some of which emerged after their search ended. In contrast, our review thoroughly integrates established stigma constructs into the SV literature across stigma levels, which represent a crucial step forward in our understanding of the consequences of SV.

Our findings also augment the review paper by Dworkin et al. (2019), who reviewed the social reactions literature. Across multiple studies in our review, greater SV stigma burden was negatively correlated with disclosure (Andresen et al., 2019; Deitz et al., 2015; Hakimi et al., 2018; Maticka-Tyndale et al., 2020). This finding is consistent with the broader disclosure literature, as summarized by Dworkin et al. (2019), which has theorized that stigma is a key factor in survivors’ decisions not to disclose an experience of SV. However, studies of social reactions typically do not measure stigma-related processes directly, instead inferring the existence of stigmatization either based on negative responses to SV disclosure or on the lack of disclosure itself (Jonzon & Lindbald, 2004; Orchowski et al., 2013; Peter-Hagene & Ullman, 2013). Consequently, the social reactions literature does not empirically test and therefore is not able to explain, why survivors of SV may not choose to disclose their experience to others, and/or why they are frequently exposed to negative social reactions when disclosing their experiences of trauma. Of particular relevance to the latter point, an investigation published after the review by Dworkin et al. (2019) found that it is stigmatizing reactions specifically, and not negative reactions more generally, that drive adverse psychosocial outcomes following IPV exposure (Overstreet et al., 2019). Our review required the inclusion of specific stigma constructs, which enabled us to explicitly test whether SV stigma per se is a critical upstream factor that influences individuals’ decisions to disclose or conceal.

Findings from our review suggest that reluctance to disclose may result from survivors’ accurate evaluation of their social context as being highly stigmatizing and therefore unlikely to produce a supportive response to their disclosure. Indeed, research has shown that gay men are more likely to conceal their sexual minority identity in contexts characterized by higher structural homophobia (Lattanner et al., 2021). Studies in our sample also found that survivors may not disclose because they are high in internalized stigma (Andresen & Blais, 2019; Gibson & Leitenberg, 2001; Quinn et al., 2014). Alternatively, survivors may choose not to disclose because they have previously experienced a negative response to disclosure (e.g., discrimination or rejection), an example of enacted stigma at the interpersonal level (Ahrens, 2006), and may therefore anticipate additional SV stigma experiences in the future. Thus, for many survivors, the decision not to disclose may be multidimensional, influenced by SV stigma at the individual, interpersonal, and structural levels. Yet none of the studies in our review that examined disclosure as an outcome included measures of SV stigma at all three levels simultaneously; thus, this hypothesis requires empirical testing in future research.

There is one disclosure-related concept from the broader stigma literature that was largely missing from the SV stigma literature, despite its potential relevance to psychosocial outcomes: identity concealment, which is conceptualized as the ongoing cognitive, affective, and behavioral efforts associated with hiding one’s identity or status from part or all of their social circle (Pachankis, 2007). Though in certain circumstances concealing a stigmatized identity can be beneficial because it enables individuals to avoid some of the prejudice and discrimination faced by visibly stigmatized people, concealment is also associated with receiving less social support and experiencing greater social isolation, as well as with negative affect and lower-self-esteem (for a review, see Pachankis, 2007). There are many reasons why a person may conceal that they are a survivor of SV, including concerns about negative responses to disclosure (e.g., rejection) or because they have internalized negative attitudes about themselves and thus do not feel deserving of the support of others.

The studies in our review have done an admirable job of measuring two aspects that are related to concealment: disclosure concerns (e.g., Eckstein, 2016; Gibson & Leitenberg, 2001; Miller et al., 2011; Quinn et al., 2014) and disclosure behaviors (e.g., Andresen & Blais, 2019; Deitz et al., 2015; Hakimi et al., 2018; Maticka-Tyndale et al., 2020). However, by focusing on disclosure exclusively, rather than on the cognitive (e.g., vigilance for cues that one’s SV experience might be suspected), affective (e.g., demoralization), and behavioral (e.g., impression management) dimensions of concealing one’s experience of SV (Pachankis, 2007), the stigma of SV literature is restricted in its understanding of the ongoing behaviors, emotions, and cognitions associated with actively concealing an experience of SV. For example, a survivor of CSA who does not disclose their experience until they move out of their childhood home could spend years or decades concealing their experience. During that time, the survivor may be constantly on guard for cues that a friend or family member could find out about the abuse. They might change the subject if the topic of abuse arises, go out of their way to manage their reputation so as not to appear sexual or “tainted,” or avoid close relationships for fear of having to disclose their history of CSA. These possibilities should be explored in future work, drawing on examples from other stigmatized groups (e.g., sexual minorities; Pachankis & Hatzenbuehler, 2013).

Our review additionally suggests that SV stigma may represent one under-examined mechanism that explains why exposure to SV is associated with more severe health outcomes than other types of trauma (Kessler et al., 2017). For example, exposure to SV stigma may hinder or eliminate survivors’ access to social support—a critical determinant of post-trauma recovery (Charuvastra & Cloitre, 2008)—by motivating survivors to conceal their experience(s) of SV, placing them at risk for interpersonal discrimination from formal and informal sources of support, and exposing them to hostile and victim-blaming cultural narratives around SV. In the absence of these experiences of SV stigma, survivors of other types of trauma may be better situated to receive validation, interpersonal support, and healthcare intervention. However, none of the studies in our sample drew upon survivors of both sexual and non-sexual traumas in order to explore this hypothesis. Thus, future research is needed to better understand how SV stigma shapes adverse outcomes among those exposed to SV.

Limitations and Future Directions for the SV Stigma Literature

Although we find consistent evidence that individual, interpersonal, and structural forms of SV stigma are associated with a range of adverse outcomes, existing studies are subject to several important limitations. First, few studies were longitudinal, which makes it difficult to rule out reverse causality in studies examining associations between SV stigma and psychopathology, as psychological distress may cause greater perceptions of SV stigma (Meyer, 2003). Second, most of the studies in our investigation employed non-probability designs. Future work should aim to incorporate more inclusive sampling methods, such as population-based samples, which can increase external validity by reducing selection biases (Mellen & Hatzenbuehler, 2023). Third, although half (49%) of the studies in our sample recruited both male and female participants, very few (n = 4; 6%) included transgender and non-binary participants, despite the increased prevalence of SV among transgender and non-binary populations (Peitzmeier et al., 2020; Ybarra et al., 2022). Future work should specifically aim to characterize the experience of SV stigma among gender-diverse samples. Similarly, the current SV stigma literature does not explore whether the experience of SV stigma may differ based on other stigmatized statuses survivors may hold, such as by race, ethnicity, sexual orientation, and/or disability status. As such, we recommend that future work apply an intersectional lens to better understand the experience and health consequences of SV stigma.

In order to enhance future research on the psychosocial consequences of SV stigma, we also highlight a number of key limitations and future directions related to SV stigma measurement. All of the studies that captured SV stigma at the interpersonal level in our review relied on self-report measures. This means that reports of discrimination must be mediated by conscious perception that one has been discriminated against due to their status as a survivor of SV. There are two key disadvantages of this approach. The first is that members of stigmatized groups can be discriminated against without their knowledge, and therefore not all instances of discrimination will be consciously perceived (Meyer, 2003). The second is that an overreliance on reports of discrimination can imply that the problem is survivors’ perceptions of discrimination, and not the discrimination itself (Meyer, 2003). Overemphasis on perception may be especially problematic when it comes to SV stigma due to the pervasiveness of victim-blaming attitudes and the frequency with which survivors hold other stigmatized identities (Chen et al., 2020; Gravelin et al., 2018; Stockman et al., 2015).

Further, a drawback relevant to both individual- and interpersonal-level measurement approaches is the possibility of confounding that can occur when both SV stigma and health outcomes are measured using self-report. In such cases, it is possible that a person’s health symptoms may modulate their reporting of stigma burden, making it difficult to determine causality (Meyer, 2003). Consequently, researchers should expand the use of objective measures of interpersonal SV stigma that do not rely on self-report, as has been done with other stigmatized groups (e.g., sexual minorities; Meyer et al., 2008).

Additionally, the vast majority of studies in our sample quantified SV stigma at the individual and/or interpersonal level. Only two investigations measured structural SV stigma using objective measures (e.g., laws, policies, and institutional practices; Dworkin et al., 2017; Nikolova et al., 2021) and an additional three studies used subjective measurement approaches to quantify survivors’ appraisals of structural SV stigma (Bernett et al., 2016, Deitz et al., 2015; Eckstein, 2016). To date, no studies have combined both measurement approaches in a single investigation. Previous work in the sexual minority stigma literature has identified a moderate degree of correlation between perceptions of structural stigma and objective measures of structural homophobia at the city, county, and state level, measured via composite indices of laws and social attitudes (Lattanner et al., 2021). Further, for gay men, perceived structural stigma mediates the relationship between objectively measured structural stigma and concealment motivation (Lattanner et al., 2021). Together, these results suggest that members of stigmatized groups are aware of and accurately appraise structural stigma within their social context. Within the SV stigma literature, further work combining objective and subjective measures of structural SV stigma is needed to understand the degree to which survivors perceive structural SV stigma and whether perceived structural stigma serves as a mediator between objectively measured structural SV stigma and adverse outcomes.

Another way to advance the measurement of structural SV stigma would be to draw on the conceptualization and operationalization of a construct in related literatures, known as institutional betrayal, which describes “institutional action and inaction that exacerbate the impact of traumatic experiences” (Smith & Freyd, 2014; p. 577). Stemming from and expanding the betrayal trauma literature, which had hitherto focused primarily on interpersonal traumatic betrayals and their associated adverse psychosocial consequences (Freyd, 1996; Freyd, DePrince, & Zurbriggen, 2001; Freyd & Birrell, 2013), the construct of institutional betrayal includes the ways in which structural failures—such as failure to prevent abuse, normalization of abusive contexts, barriers to reporting harmful conduct, institutional coverups, and punishments for victims and whistleblowers—exacerbate trauma symptoms (Smith & Freyd, 2013, 2014). Though not specific to sexual trauma, institutional betrayal has been identified as a particularly pervasive and psychologically distressing experience among survivors of SV (Andresen et al., 2019; Monteith et al., 2022; PettyJohn et al., 2023; Sall & Littleton, 2022; Smith & Freyd, 2013, Smith et al., 2016). These findings underscore the urgency of developing measures that can capture stigma at the structural level, particularly those that incorporate objective structural factors such as laws, policies, and institutional practices.