Violence Against Women

Volume 15 Number 2
February 2009 148-167
© 2009 Sage Publications
10.1177/1077801208329386
If She Is Not a Victim, Does http://vaw.sagepub.com
hosted at
That Mean She Was Not http://online.sagepub.com

Traumatized?
Evaluation of Predictors of PTSD
Symptomatology Among College
Rape Victims
Heather Littleton
East Carolina University
Craig E. Henderson
Sam Houston State University

The issue of whether individuals can be traumatized by the experience of rape if they
do not label the experience a victimization remains controversial. Indeed, there are con-
flicting findings with regard to the extent to which such unacknowledged victims expe-
rience posttraumatic symptoms. The goal of the current study was to evaluate
acknowledgment status as a predictor of posttraumatic stress disorder symptomatology
using structural equation modeling among a sample of 346 college rape victims.
Results showed that whereas acknowledged victims reported more symptoms of post-
traumatic stress disorder, acknowledgment status did not add to the prediction of post-
traumatic stress disorder symptoms in a model including assault violence and other
important predictors of these symptoms.

Keywords: PTSD; rape acknowledgment; sexual assault; structural equation modeling

ape is unfortunately an all-too-common experience in the lives of young

R women. Although definitions vary somewhat from state to state, most
researchers define rape as unwanted sex obtained by threat, force, or the assault of a
victim who is incapable of consenting (e.g., as a result of drinking alcohol or using
substances; Abbey, BeShears, Clinton-Sherrod, & McAuslan, 2004). Indeed, all
states now include a provision in their statutes that victims may be unable to consent
to sex as a result of drinking alcohol or using other drugs (Cole, 2006). Recent preva-
lence estimates for rape among women using these criteria have ranged from 14% to

Authors’ Note: This study was supported in part by a grant-in-aid from the Society for the Psychological
Study of Social Issues (H. Littleton). We gratefully acknowledge Fred Anthony Miller, who developed the
online data-collection program.

148

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 Littleton, Henderson / College Rape Victims 149

22% in college, community, and medically recruited samples (Abbey et al., 2004;
Arata, 1999; Brener, McMahon, Warren, & Douglas, 1999; Cloutier, Martin, &
Poole, 2002; Kahn, Jackson, Kully, Badger, & Halvorsen, 2003; Littleton, Radecki
Breitkopf, & Berenson, 2008; Masho, Odor, & Adera, 2005).
The experience of rape is frequently associated with the development of significant
and persistent psychological distress. This distress often takes the form of posttraumatic
stress disorder (PTSD), which includes reexperiencing the trauma in the form of
unwanted thoughts, images, and dreams; avoidance of reminders of the trauma, such as
certain situations or people; and increased arousal, such as the development of insomnia
or a heightened startle response (American Psychiatric Association, 1994). Between one
half and nearly two thirds of rape victims develop PTSD following this trauma (Breslau
et al., 1998; Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992), including chronic PTSD.
For example, one community sample found that the median duration of PTSD following
interpersonal trauma was 4 years (Breslau et al., 1998). In another example, Kilpatrick,
Saunders, Veronen, Best, and Von (1987), using a random community sample of rape
victims, found that 16% met criteria for current PTSD, even though the rape had
occurred on average 17 years earlier. Rape victims also often experience other forms of
psychological distress. For example, in a community sample of women, 39% of rape
victims met current criteria for either an anxiety disorder other than PTSD or major
depression (Boudreaux, Kilpatrick, Resnick, Best, & Saunders, 1998).
Many women who report experiences that meet a legal definition of rape do not
label their experience as such or even as a victimization. Studies of college rape
victims have found that between 47% and 73% do not label their experience a rape
or a victimization; these victims are referred to as unacknowledged victims
(Bondurant, 2001; Botta & Pingree, 1997; Fisher, Daigle, Cullen, & Turner, 2003;
Frazier & Seales, 1997; Layman, Gidycz, & Lynn, 1996; Littleton, Axsom, Radecki
Breitkopf, & Berenson, 2006; McMullin & White, 2006). Research with noncollege
victim samples similarly suggests that a sizable percentage of rape victims do not
acknowledge these unwanted sexual experiences as rapes (Conoscenti & McNally,
2006; Koss, Figueredo, Bell, Tharan, & Tromp, 1996; Littleton et al., 2008; Russell,
1982). Instead, they give their experience a much more benign label, such as a mis-
communication or bad sex, or state that they are unsure how to label their experience
(Littleton et al., 2006; Littleton et al., 2008).
A number of differences have been found in the assault experiences of unacknowl-
edged and acknowledged rape victims. The most consistent finding is that the assaults
of unacknowledged victims are less violent, involving less force by the assailant, resis-
tance by the victim, and injury to the victim (Bondurant, 2001; Botta & Pingree, 1997;
Fisher et al., 2003; Kahn, Andreoli Mathie, & Torgler, 1994; Layman et al., 1996;
Littleton et al., 2006; Littleton et al., 2008). Some studies have also found that unac-
knowledged rapes are more likely than acknowledged rapes to involve alcohol use by
the victim and the perpetrator (Bondurant, 2001; Botta & Pingree, 1997; Layman et al.,
1996; Littleton et al., 2008; McMullin & White, 2006). In addition, unacknowledged

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150 Violence Against Women

victims are more likely than acknowledged victims to report that they were romantically
involved with the perpetrator (Frazier & Seales, 1997; Kahn et al., 2003; Koss, 1985;
Koss, Dinero, Seibel, & Cox, 1988; Littleton et al., 2008) and that they engaged in con-
sensual sexual activity with the perpetrator prior to the assault (Koss, 1985).
The fact that many unacknowledged assaults resemble a normative sexual interac-
tion to a certain extent (e.g., they are not highly violent, they occur within the context
of a relationship wherein sexual activity would be considered normative), combined
with the fact that the victims themselves do not view the experience as a victimization,
has led some social critics to dismiss the notion that these individuals are traumatized
by this experience or that they should be considered victims (see Gavey, 1999, for a
review). Supporting the possibility that unacknowledged victims are less traumatized
by the experience, Kahn and Andreoli Mathie (2000) found that unacknowledged
victims reported feeling less victimized and less negative affect during the rape than
acknowledged victims. In a subsequent study, Kahn and colleagues (2003) found that
unacknowledged victims reported less negative affect following the assault than
acknowledged victims. Studies that have directly assessed whether unacknowledged or
acknowledged victims differ in postvictimization psychological distress have had
equivocal findings. Several studies found no differences in general distress (e.g., neg-
ative affect) between unacknowledged and acknowledged victims (Frazier & Seales,
1997; Koss, 1985; Layman et al., 1996; Littleton et al., 2006). In contrast, Botta and
Pingree (1997) found in a sample of 62 acknowledged and 34 unacknowledged victims
that unacknowledged victims were more poorly adjusted than acknowledged victims
in several domains, including current negative affect, interference in activities due to
emotional problems, and alcohol use. Concerning PTSD symptomatology, three stud-
ies found that acknowledged victims reported more PTSD symptomatology than unac-
knowledged victims (Koss et al., 1996; Layman et al., 1996; Littleton et al., 2006),
whereas one study found no difference in PTSD symptomatology between unac-
knowledged and acknowledged victims in a sample of 26 unacknowledged and 19
acknowledged victims (Marx & Soler-Baillo, 2005). Although it is difficult to interpret
these equivocal findings, one possible explanation is that a number of studies in this
area have been limited by low power to detect all but large differences in distress
between unacknowledged and acknowledged victims (Littleton, Rhatigan, & Axsom,
2007). For example, Koss (1985) evaluated distress among a sample of 36 acknowl-
edged and 26 unacknowledged victims, and Layman and colleagues (1996) evaluated
distress among a sample of 40 unacknowledged and 20 acknowledged victims. In addi-
tion, these studies did not control for potential confounding variables (e.g., assault vio-
lence) that may account for differences in distress between acknowledged and
unacknowledged victims rather than the acknowledgment itself. Overall, however,
these studies suggest the possibility that at least some unacknowledged victims can be
distressed and potentially traumatized by their experience.
The most comprehensive study specifically evaluating whether the experience
of sexual victimization produces distress, regardless of acknowledgment status, was

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 Littleton, Henderson / College Rape Victims 151

conducted by Harned (2004). Using path analysis, she examined two competing mod-
els. In the first, the experience of unwanted sex predicted participants’ labeling the expe-
rience a victimization, and in turn, labeling predicted greater distress. In the second,
unwanted sexual experiences predicted both participants’ labeling the experience a vic-
timization and distress, and there was no direct relationship between labeling and dis-
tress. She found stronger support for the latter model. Although the findings from
Harned’s study are intriguing, it is important to note some limitations of the study. These
include restricting analyses only to victims of assaults in dating relationships and inclu-
sion of victims of multiple types of unwanted sexual experiences, in addition to rape. In
addition, Harned did not specifically evaluate the role of acknowledgment status in pre-
dicting victims’ symptoms of PTSD, despite some evidence that unacknowledged
victims may experience fewer PTSD symptoms than acknowledged victims, even if the
two groups do not differ in general distress (Koss et al., 1996; Layman et al., 1996;
Littleton et al., 2006). Such comparisons are also necessary to conclusively state that
unacknowledged victims do not experience trauma symptoms following the assault.
To summarize, there is moderately strong evidence that unacknowledged sexual
assault can be a distressing experience, and the fact that the victim does not acknowledge
the rape does not necessarily mean that she is not distressed by the experience. However,
the evidence suggesting that unacknowledged victims’ distress is expressed as trauma
symptoms is equivocal. Thus, the primary goal of the current investigation was to evalu-
ate through structural equation modeling (SEM) the role of acknowledgment status as a
predictor of PTSD symptomatology among rape victims. We accomplished this goal by
evaluating the extent to which (a) acknowledgment status predicted PTSD symptoma-
tology and (b) whether inclusion versus exclusion of the relationship between acknowl-
edgment and PTSD symptoms affected overall model fit. In the latter case, if model fit
was unaffected by including versus excluding the path between acknowledgment and
PTSD symptoms, we would reject the model including this path for the more parsimo-
nious model in which it was excluded. On the basis of this evidence, we would conclude
that victims’ unwanted sexual experiences are related to PTSD symptoms regardless of
whether the victims acknowledge that these experiences were indeed victimizations.
Given previous work suggesting that experiencing a more violent assault is asso-
ciated with acknowledging the rape (e.g., Bondurant, 2001; Botta & Pingree, 1997;
Kahn et al., 1994; Layman et al., 1996; Littleton et al., 2006) and that experiencing
a more violent assault is associated with greater PTSD symptomatology (e.g.,
Ullman, Townsend, Filipas, & Starzynski, 2007), we included assault violence in the
model as a predictor of acknowledgment and PTSD symptomatology. In addition,
greater reliance on maladaptive coping, such as avoidant and ruminative strategies,
has been related to experiencing more PTSD symptomatology among rape victims
(Dunmore, Clark, & Ehlers, 2001; Ullman & Filipas, 2001; Ullman et al., 2007) as
well as victims of other forms of interpersonal violence (Dunmore et al., 2001;
Johnson, Sheahan, & Chard, 2003). Greater assault violence has also been associ-
ated with more reliance on maladaptive coping (Littleton & Radecki Breitkopf,

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152 Violence Against Women

2006). Thus, maladaptive coping was included in the model as a predictor of PTSD
symptomatology, and assault violence was included as a predictor of maladaptive
coping. Finally, social support has been found to act as a protective factor with
regard to victims’ use of maladaptive coping following rape, such that victims with
stronger support networks engage in less maladaptive coping (Ullman et al., 2007).
Thus, social support was included in the model as a predictor of maladaptive coping.

Method

Participants
A total of 1,744 women, recruited from the psychology department participant
pools of three southern universities, participated for course credit during two acade-
mic semesters (fall 2006 and spring 2007). A total of 353 women, 20.2% of the sam-
ple, responded positively to a screening questionnaire assessing sexual assault
experiences in adolescence or adulthood. Because we were interested in evaluating
acknowledgment status as a predictor of PTSD symptoms, 7 (1.9%) participants who
did not indicate their acknowledgment status were eliminated from further analyses.
Unfortunately, these individuals generally had extensive missing data, precluding
analyses comparing characteristics of included and excluded participants. The aver-
age age of the 346 included women was 21.7 years (SD = 5.6, range 18-54 years).
Seventy-three percent characterized their ethnicity as European American, 8.1% as
Latina, 6.4% as Black or Caribbean Islander, 5.8% as Asian or Pacific Islander, 2.3%
as multiethnic, and 0.6% as Native American, and 4.3% did not indicate their eth-
nicity. Participants from the three universities differed in the percentage of women
who self-identified as ethnic minorities, χ2(2) = 33.10, p < .001 (24.2%, 45.2%,
14.0%). Participants also differed in their mean age, F(2, 333) = 34.14, p < .001
(23.39 years, 24.33 years, 19.41 years). However, there were no significant differ-
ences in the percentage of women at each university reporting a sexual assault expe-
rience, χ2(2) = 2.95, p = .229 (18.7%, 22.3%, 18.6%).

Procedures
Data were collected using an online survey. Potential participants were recruited
using posted fliers and announcements on psychology department research partici-
pant management Web sites at the three universities. Posted information stated that
participants would be asked to complete a confidential survey about their negative
sexual experiences, coping, and psychological health. Participants were excluded if
they were male or younger than 18 years of age. Some form of student identification
was collected to award course credit and to prevent duplicate participation (student
identification information was removed from the data files prior to data processing).

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 Littleton, Henderson / College Rape Victims 153

Participants were given a brief description of the study and information about
available counseling resources and were asked to provide their electronic consent.
Behaviorally specific screening questions were used to determine if participants had an
experience in adolescence or adulthood that would meet a legal definition of rape or sex-
ual assault. Participants who confirmed having had a sexual assault experience were
asked several questions about the circumstances of their “experience with unwanted sex-
ual contact” (or the most serious experience if they had multiple experiences). They were
also given eight potential labels for the assault: rape, attempted rape, some other type of
crime, miscommunication, seduction, hook-up, bad sex, and not sure. Those who did not
label the assault a victimization (i.e., rape, attempted rape, or another crime) were clas-
sified as unacknowledged. Participants also completed measures assessing their assault-
related coping strategies and posttraumatic stress symptoms. The study was approved by
the institutional review boards of the three universities and followed the guidelines for
ensuring the confidentiality of online data outlined by Reips (2002).

Measures
Victimization items. Two behaviorally specific screening items to assess experi-
ences of rape since the age of 14 were derived from the Sexual Experiences Survey
(Koss & Gidycz, 1985). The items were developed to be consistent with the defini-
tions of rape and sexual assault in the Commonwealth of Virginia and the state of
Texas, the commonwealth and state in which the research was conducted. The items
assessed experiences of unwanted sex (vaginal, oral, or anal intercourse or object
penetration) that was obtained by force or by threat of force or that occurred when
the individual was incapacitated or unconscious, such as from alcohol or drugs.

Assault characteristics questionnaire. Victims completed a questionnaire

regarding the circumstances of their rape experience (or the one they regarded as
most serious, if they had multiple experiences). The questionnaire was based on one
developed previously (Littleton & Radecki Breitkopf, 2006). The questionnaire
included several items assessing the violence of the assault. Two variables were con-
structed regarding the types of force that the victim reported the assailant used from
a list provided: moderate physical force (using his superior body weight, twisting
your arm or holding you down) and severe physical force (hitting or slapping you,
choking or beating you, showing or using a weapon). Victims were also asked if the
assailant had engaged in verbal threats to harm them or others. Three resistance vari-
ables were constructed regarding the types of resistance strategies victims reported
using during their assault from a list provided: nonverbal resistance (turned cold,
cried), verbal resistance (reasoned or pleaded with him, screamed for help), and
physical resistance (ran away, physically struggled). Specifically, we coded whether
the participant reported each assault element as present or absent.

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154 Violence Against Women

Victims were asked to indicate their relationship with the assailant at the time of
the experience of unwanted sexual contact from a list provided. The relationship
with the assailant was then coded as unknown/minimal (stranger, just met), acquain-
tance (friend, acquaintance), romantic (dating casually, steady date, romantic part-
ner), or relative. The victim also estimated the number of standard drinks both she
and the assailant had consumed prior to the assault. Victim and assailant drinking
level was then coded as binge or nonbinge (four standard drinks by the participant,
five standard drinks by the assailant; National Institute on Alcohol Abuse and
Alcoholism, 2006). Victims also indicated whether they had disclosed the assault
and the number of individuals to whom they had disclosed the experience.
Participants indicated their relationship with the individuals to whom they had dis-
closed from a list provided. Participants’ disclosure was coded as being to informal
sources (e.g., relative, sibling, boyfriend/partner, friend) and to formal sources (e.g.,
police, doctor/nurse/health care provider, counselor). Finally, victims reported the
number of months that had elapsed since the assault occurred.

Coping Strategies Inventory. The 32-item short form of the Coping Strategies
Inventory (Tobin, Holroyd, Reynolds, & Wigal, 1989) was administered to assess
victims’ strategies in coping with the assault. This measure assesses two main types of
coping: engagement and disengagement. The entire measure was administered, however,
because use of avoidance and ruminative strategies have predicted PTSD symptomatol-
ogy (Branscombe, Wohl, Owen, Allison, & N’gbala, 2003; Littleton, Horsley, John, &
Nelson, 2007); we examined only scores on the disengagement coping scales. The dis-
engagement coping scales are problem avoidance (I avoided thinking or doing anything
about the situation), wishful thinking (I hoped a miracle would happen), social with-
drawal (I spent more time alone), and self-criticism (I criticized myself for what hap-
pened). Both the problem avoidance and the social withdrawal scales appear to measure
avoidance coping strategies. The wishful thinking and self-criticism scales appear to
measure ruminative coping and unproductive counterfactual thinking (e.g., blaming one-
self for the sexual assault, wishing the assault had not occurred). For each item, individ-
uals rated how often they used the coping strategy with the experience of unwanted
sexual contact identified on a 5-point Likert-type scale anchored by 1 (not at all) and 5
(very much). Alpha coefficients of the scales have averaged .70 (Tobin, 2001). In the cur-
rent study, alpha coefficients ranged from .67 (problem avoidance) to .90 (self-criticism).

PTSD Symptom Scale. The PTSD Symptom Scale (Foa, Riggs, Dancu, &
Rothbaum, 1993) is a brief measure designed to assess symptoms of posttraumatic
stress. The measure contains three scales assessing the three types of PTSD symptoms:
reexperiencing, avoidance, and arousal. A sample item is, “Having bad dreams or
nightmares about the event.” In the current study, for each item, individuals rated how
often they have had the symptom in the past week in connection to their experience of
unwanted sexual contact on a 4-point Likert-type scale anchored by 0 (not at all or

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 Littleton, Henderson / College Rape Victims 155

only one time) and 3 (five or more times per week/almost always). Cronbach’s alpha
for the scales in a previous study of rape victims ranged from .78 to .82 (Foa et al.,
1993) and in the current study ranged from .84 to .86. In addition, the PTSD Symptom
Scale was found to have a sensitivity of 62% and specificity of 100% for the diagno-
sis of PTSD when compared with a structured clinical interview (Foa et al., 1993).

Multidimensional Scale of Perceived Social Support. The Multidimensional

Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988) is a 12-
item measure of perceived social support adequacy. The Multidimensional Scale of
Perceived Social Support has three subscales: support from family (I can talk about
my problems with my family), support from friends (my friends really try to help
me), and support from a significant other (I have a special person who is a real
source of comfort to me). For each item, individuals indicated the extent to which
they agreed with the statement on a 7-point Likert-type scale bounded by 1 (very
strongly disagree) and 7 (very strongly agree). Cronbach’s alpha of the scales in a
college student sample ranged from .85 to .91 (Zimet et al., 1988) and in the current
sample ranged from .93 to .96. Factor analysis with a college sample supported the
three-factor structure of the measure (Zimet et al., 1988).

Analysis Plan
The main hypotheses in this study were tested with a series of latent variable (LV)
structural equation models fitting the hypothesized model to the sample covariance
matrix using the Mplus program (Version 4.21; Muthén & Muthén, 1998-2007). To
assess model fit, in addition to the model χ2, we also examined three fit indices, the
root-mean-square error of approximation (RMSEA), the comparative fit index (CFI),
and the Tucker-Lewis Index (TLI). The RMSEA assesses model misfit per degree of
freedom, and previous research has indicated that values of approximately .06 or less
are indicative of good fit (Hu & Bentler, 1999). The CFI and TLI measure improve-
ment in fit when the model tested is compared to an independence model in which the
variables are uncorrelated with one another. Previous research has indicated that
CFI/TLI values close to .95 are indicative of good fit (Hu & Bentler, 1999). It should
be noted that in moderately sized samples (N > 200), the chi-square test tends to be
inflated and may reach significance even with adequately fitting models (Kline,
2005). Therefore, when discrepancies between the chi-square test and other fit indices
arose, we relied more heavily on the supplemental fit indices.
The order of analyses was as follows. First, we used confirmatory factor analysis
to evaluate three LV measurement models created from the subscales of the Coping
Strategies Inventory, PTSD Symptom Scale, and Multidimensional Scale of
Perceived Social Support. In addition, we created an LV measurement model from
five assault violence indicators (verbal resistance, nonverbal resistance, physical
resistance, moderate physical force, severe physical force). Finally, we modeled

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156 Violence Against Women

assault acknowledgment as an observed manifest dichotomous item in the structural

equation models described more fully below. Because the assault violence items
were specified as categorical indicators in the structural equation models, means,
variances, and covariances are not sufficient statistics under maximum likelihood
estimation, and thus Mplus does not produce either the chi-square test of absolute fit
or other model fit indices (Linda Muthén, personal communication, April 14, 2007).
Therefore, we used the weighted least squares estimator to examine all LV models.1
Modification indices (Lagrange Multiplier and Wald tests) were examined to deter-
mine if model fit could be improved by either constraining or freeing parameters.
Next, we tested the two structural equation models, the only difference between
them being whether acknowledgment status was included in the model as a predic-
tor of PTSD symptomatology. We used a chi-square difference test to determine
whether including assault acknowledgment in the model produced superior fit com-
pared to when it was removed. A nonsignificant chi-square difference test would
indicate that the two models did an equally good job of reproducing the observed
data. However, in most SEM applications, the original model is retained when the
chi-square difference test is not significant because retaining the nested model is tan-
tamount to rejecting a null hypothesis on the basis of nonsignificant effects, a logi-
cal error that is well documented in the literature (Keppel, 1991). Therefore, we also
used the Bayesian Information Criterion (Schwarz, 1978) to help guide our selection
of the final model, with smaller values indicating better fit.

Results

Sample Characteristics
The majority of women, 61%, were unacknowledged rape victims, whereas 39%
were acknowledged. Of unacknowledged victims, 46% were unsure how to label
their experience, 38% labeled it a miscommunication, 9% a hook-up, 4% bad sex,
and 3% a seduction. Of acknowledged victims, 66% labeled their experience a rape,
24% an attempted rape, and 10% some other type of crime. Characteristics of par-
ticipants’ assaults, broken down by acknowledgment status, are summarized in Table
1. The majority of assaults involved the use of physical force by the assailant, and
the majority of victims engaged in some form of resistance, although the assaults of
acknowledged victims were more likely to involve both force by the assailant and
resistance by the victim. However, it should be noted that few participants reported
that their assault involved the use of severe force.
Consistent with prior research, the vast majority of participants knew their assailants,
although most reported fairly casual relationships with them (e.g., acquaintance, friend).
Unacknowledged victims were more likely to report a romantic relationship with the
assailant than acknowledged victims. A sizable percentage of victims reported that they

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 Littleton, Henderson / College Rape Victims 157

Table 1
Assault Characteristics of Victims in the Sample (n = 346)
Acknowledged Unacknowledged
(n = 135) (n = 211)

% n % n χ2

Force by assailant
Verbal threats 28.1 38 9.0 19 21.93***
Moderate force 81.5 110 54.5 115 26.35***
Severe force 11.9 16 2.4 5 12.98***
Resistance by victim
Nonverbal 66.7 90 55.5 117 4.31*
Verbal 52.6 71 32.7 69 13.52***
Physical 57.0 77 30.3 64 24.32***
Relationship with assailant
Unknown/minimal 22.2 30 15.2 32 2.79
Acquaintance 46.7 63 46.0 97 0.02
Romantic 25.9 35 37.4 79 4.94*
Relative 5.2 7 1.4 3 4.15*
Binge drinking by victim 37.9 50 64.5 136 23.11***
Binge drinking by assailant 36.1 48 51.2 108 7.50**
Disclosed the assault 83.7 113 74.4 157 4.15*
Informal disclosure 93.8 106 93.6 147 0.00
Formal disclosure 36.3 41 9.6 15 28.56***

*p < .05. **p < .01. ***p < .005.

had engaged in binge drinking prior to the assault and that their assailant had engaged
in binge drinking, with unacknowledged victims’ being more likely to report that their
assault involved binge drinking. The majority of victims reported that they had dis-
closed the assault, with acknowledged victims being more likely to disclose overall.
Among victims who had disclosed, nearly all reported that they had disclosed to an
informal support provider. A minority of victims had disclosed to a formal support
source, with acknowledged victims being more likely to have done so. Assaults had
occurred an average of 44 months previously, although the amount of time since the
assault varied greatly (range = 0-480 months, SD = 59 months). Unacknowledged
assaults occurred more recently than acknowledged assaults, t(232) = 45.63, p < .001
(unacknowledged M = 30 months, acknowledged M = 67 months).
Descriptive statistics for the observed nondichotomous variables used in the analy-
ses are summarized in Table 2. On average, participants reported moderate use of
maladaptive coping strategies, high levels of satisfaction with their social support, and
low to moderate levels of PTSD symptomatology. Thirty-six percent of victims
reported sufficient symptoms of PTSD symptomatology on the PTSD Symptom
Scale to meet diagnostic criteria for a current diagnosis (one reexperiencing

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158 Violence Against Women

Table 2
Descriptive Statistics for Observed Variables
Measure M SD Possible Range Skew Kurtosis

Maladaptive coping
Problem avoidance 13.01 3.67 4-20 0.03 −0.69
Wishful thinking 13.35 3.71 4–20 −0.33 −0.41
Social withdrawal 9.29 4.25 4-20 0.55 −0.58
Self-criticism 11.69 4.71 4–20 0.16 −1.06
Posttraumatic stress disorder
Reexperiencing 2.35 2.84 0–15 1.58 2.71
Avoidance 4.21 4.57 0–21 1.14 0.69
Arousal 4.04 3.93 0-15 0.71 −0.47
Social support
Family support 20.42 6.87 4–28 −0.82 −0.27
Friend support 22.51 5.78 4–28 −1.20 0.92
Intimate support 23.26 6.30 4–28 −1.45 1.41

Table 3
Correlations Among Observed Nondichotomous Variables
1 2 3 4 5 6 7 8 9 10

1. Problem avoidance —
2. Wishful thinking .39 —
3. Social withdrawal .14 .49 —
4. Self-criticism .23 .52 .42 —
5. Reexperiencing .07 .40 .44 .21 —
6. Avoidance .15 .37 .47 .27 .74 —
7. Arousal .12 .35 .52 .22 .63 .71 —
8. Family support −.05 −.12 −.26 −.16 −.18 −.23 −.25 —
9. Friend support −.11 −.15 −.26 −.15 −.11 −.18 −.20 .51 —
10. Intimate support −.02 −.05 −.16 −.12 −.13 −.16 −.20 .40 .51 —

Note: Covariance matrix available from authors by request.

symptom, three avoidance/numbing symptoms, and two arousal symptoms; American

Psychiatric Association, 1994). More acknowledged than unacknowledged victims
reported sufficient symptoms to suggest they met diagnostic criteria for PTSD,
χ2(1) = 10.05, p < .01 (47% acknowledged, 30% unacknowledged). Acknowledged
victims also reported more PTSD symptomatology overall, t(341) = 4.47, p < .001
(acknowledged M = 13.56, SD = 10.90, unacknowledged M = 8.68, SD = 9.16). Skew
and kurtosis values for all observed variables were acceptable; thus, no transforma-
tions of observed variables were conducted prior to analyses (Kline, 2005). Pearson
correlation coefficients among the nondichotomous variables are reported in Table 3.

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 Littleton, Henderson / College Rape Victims 159

Confirmatory Factor Analyses

Initial confirmatory factor analyses suggested that the indicator representing
problem avoidance was not strongly related to the maladaptive coping LV (β = .37).
Thus, problem avoidance was removed from the model. Each of the remaining man-
ifest variables was moderately to strongly associated with the LV (wishful thinking:
β = .78, self-criticism: β = .67, social withdrawal: β = .63). For PTSD symptoma-
tology, each of the manifest variables was strongly associated with the LV (reexpe-
riencing: β = .81, avoidance: β = .91, arousal: β = .78). For the social support LV,
each of the manifest variables was moderately to strongly associated with the LV
(family support: β = .64, friend support: β = .80, intimate support: β = .63). A mea-
surement model including each of the three LVs with nondichotomous indicators
and the covariances between them also demonstrated adequate model fit, χ2(24) =
62.30, p < .001, CFI = .96, TLI = .94, RMSEA = .07.
Initial confirmatory factor analysis of the assault violence LV suggested that the
indicator representing nonverbal resistance was not strongly related to the LV (β =
.12). Thus, nonverbal resistance was removed from the model. Because the assault
violence indicators consisted of dichotomous items reflecting the presence or
absence of assault characteristics, traditional fit indices were not available to judge
model fit. However, the likelihood ratio χ2 test of the confirmatory factor analysis
after removing the nonverbal resistance indicator was not significant, χ2(2) = 3.66,
p = .16, and each of the indicators showed moderate to strong associations with the
LV (moderate physical force: β = .94, severe physical force: β = .53, verbal resis-
tance: β = .60, physical resistance: β = .78).

Structural Equation Models

The first structural model (see Figure 1) tested the effects of maladaptive coping,
assault violence, and assault acknowledgment on PTSD symptoms. In addition, use
of maladaptive coping was predicted by assault violence and social support. Finally,
assault acknowledgment was predicted by assault violence. The model test revealed
that although the χ2 test of exact fit was significant, χ2(30) = 71.76, p < .001, the other
model fit indices generally indicated that the data fit the model adequately (CFI = .90,
TLI = .93, RMSEA = .06).2 As shown in Figure 1, a significant direct effect on PTSD
symptoms was found with maladaptive coping (β = .64, p < .001), such that greater
reliance on maladaptive coping was associated with greater PTSD symptomatology.
In contrast, both assault violence (β = .06, p = .27) and acknowledgment status
(β = –.11, p = .06) did not significantly predict PTSD symptoms. The model overall
accounted for 50% of the variance in PTSD symptoms. Assault violence (β = .31,
p < .001) and social support (β = –.33, p < .001) significantly predicted maladaptive
coping and accounted for 25% of the variance in maladaptive coping. Specifically,
greater assault violence was associated with greater reliance on maladaptive coping,

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160 Violence Against Women

Figure 1
Results of Latent Variable Structural Equation Modeling
Including Acknowledgment Status as a Predictor of
Posttraumatic Stress Disorder (PTSD) Symptoms

Family Wishful Social Self-

.78 thinking withdrawal criticism
support

Social .87
Friendship .73 .63
Support –.33 .44
support
.56 Maladaptive
Intimate Coping
support
.64

Re-experiencing
.31 .78
Moderate
force .89
PTSD .85
Severe .06 Symptomatology Avoidance
.69
force
Assault
.56 .87
Verbal Violence
resistance
Arousal
.74 –.11
Physical
resistance -.61

Acknowledgment
Status

and less social support satisfaction was associated with greater reliance on maladap-
tive coping. In addition, assault violence predicted acknowledgment (β = –.61,
p < .001), such that greater assault violence was associated with greater likelihood of
being an acknowledged victim. Assault violence was indirectly associated with PTSD
symptomatology through maladaptive coping (β = .20, p < .001) and nonsignificantly
associated with PTSD symptomatology through acknowledgment status (β = .06,
p = .27). Social support was also significantly indirectly associated with PTSD symp-
tomatology through maladaptive coping (β = –.21, p < .001). In addition, all the
model modification indices values were less than 15.0.
In the model shown in Figure 2, PTSD symptoms are not predicted from assault
acknowledgment. As with the previous model, the χ2 test for exact fit was significant,
χ2(30) = 71.76, p < .001; however, the model fit indices generally suggested that the
data fit this model adequately (CFI = .90, TLI = .93, RMSEA = .06). The likelihood
ratio difference test indicated that the model fits for the two competing models were
virtually indistinguishable, ∆χ2(1) = 0.18, ns. The Bayesian Information Criterion for
the hypothesized model was also smaller than that for the previous model in which

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 Littleton, Henderson / College Rape Victims 161

Figure 2
Results of Latent Variable Structural Equation Modeling
Without Acknowledgment Status as a Predictor of
Posttraumatic Stress Disorder (PTSD) Symptoms

Family Wishful Social Self-

.78 thinking withdrawal criticism
support

Social .87
Friendship .73 .63
Support –.33 .44
support
.55 Maladaptive
Intimate Coping
support
.64

Re-experiencing
.31 .78
Moderate
force .89
PTSD .85
Severe .13 Symptomatology Avoidance
.69
force
Assault
.56 .87
Verbal Violence
resistance
Arousal
.74
Physical
resistance -.61

Acknowledgment
Status

PTSD symptoms were predicted by assault acknowledgment (path included: Bayesian

Information Criterion = 18,951.22; path dropped: Bayesian Information Criterion =
18,945.59). In this model, a significant direct effect with PTSD symptoms was found
for maladaptive coping (β = .64, p < .001); however, the path from assault violence to
PTSD symptoms was not significant (β = .13, p = .05). The model accounted for 49%
of the variance in PTSD symptoms. Assault violence (β = .31, p < .001) and social sup-
port (β = –.33, p < .001) significantly predicted maladaptive coping, and the model
explained 25% of the variance in maladaptive coping. In addition, acknowledgment
(β = –.61, p < .001) was significantly predicted by assault violence. Assault violence
(β = .20, p < .001) and social support (β = –.21, p < .001) had significant indirect
effects on PTSD symptoms through maladaptive coping. Finally, like the previous
models, all of this model’s modification indices were less than 15.0.
Because there were differences between acknowledged and unacknowledged
victims in the amount of time that had passed since the assault, whether the victim
and assailant had engaged in binge drinking at the time of the rape, and the rela-
tionship the victim had with the assailant, we examined whether any of these vari-
ables predicted PTSD symptomatology. First, months since the assault occurred was

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162 Violence Against Women

added to the model (depicted in Figure 2) as a predictor of PTSD symptomatology.

Because months since assault did not significantly predict PTSD symptoms (β = –.05,
p = .25), we removed it from the model. Next, binge drinking by the victim and
assailant were added to the model as predictors of PTSD symptoms. However, this
model showed poor fit to the data, χ2(38) = 98.69, p < .001, CFI = .86, TLI = .88,
RMSEA = .07, and likewise these variables were removed from the model. Finally, the
victim’s relationship with the assailant (romantic/nonromantic) did not significantly
predict PTSD symptoms (β = .01, p = .43) and thus was removed from the model.

Discussion

As in some previous studies, unacknowledged victims reported fewer symptoms

of PTSD than acknowledged victims and were less likely to report sufficient current
symptoms of PTSD to suggest they met diagnostic criteria for this disorder. However,
it is notable that despite the fact that unacknowledged assaults were significantly less
violent than acknowledged assaults, and the victims themselves did not characterize
the experience as a victimization, a sizable percentage (30%) of unacknowledged
victims’ responses suggested they met current diagnostic criteria for PTSD. In the
structural equation model, acknowledgment status did not emerge as a significant pre-
dictor of PTSD symptomatology, and the addition of a path from acknowledgment
status to PTSD did not result in improvement in model fit. In addition, removal of the
path from acknowledgment to PTSD symptomatology did not affect the amount of
variance in PTSD symptomatology explained. The structural equation model also
suggested that assault violence may be a potential mechanism to explain differences
in PTSD symptomatology. As predicted, less violence in the assault was associated
with being an unacknowledged victim. In addition, greater assault violence was asso-
ciated with greater PTSD symptomatology, primarily through the relation between
assault violence and reliance on maladaptive coping. It is also worth noting that other
variables in which unacknowledged and acknowledged victims differed (months
since assault, binge drinking during the assault, being romantically involved with the
assailant) did not improve the prediction of PTSD symptoms or overall model fit.
The results also provide some intriguing findings regarding the roles of assault vio-
lence, maladaptive coping, and social support in predicting PTSD symptomatology.
Unlike in some prior research (e.g., Bownes, O’Gorman, & Sayers, 1991; Kilpatrick
et al., 1989), assault violence was not directly associated with PTSD symptomatol-
ogy. However, greater assault violence was associated with greater reliance on mal-
adaptive coping strategies with respect to the rape and indirectly predicted PTSD
symptomatology through coping. Thus, one possibility is that victims of more violent
assaults are more likely to turn to maladaptive avoidant and ruminative strategies in
coping with the rape, perhaps because they are more likely to experience negative
cognitions during the assault and high levels of trauma symptoms immediately

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 Littleton, Henderson / College Rape Victims 163

afterward (Dunmore, Clark, & Ehlers, 1999, 2001). Reliance on these maladaptive
strategies could then lead to a perpetuation and exacerbation of PTSD symptomatol-
ogy through several processes including avoidance attempts leading to paradoxical
hyperattention to trauma-related thoughts (Snyder & Pulvers, 2001) and perpetuation
of symptomatology by maladaptive ruminative strategies such as self-criticism and
unproductive counterfactual thinking (Branscombe et al., 2003). Similarly, social sup-
port was not a direct predictor of PTSD symptomatology but instead was indirectly
associated with PTSD symptomatology through its relationship with maladaptive
coping. There are a number of potential ways in which social support could influence
victims’ coping strategies. For example, individuals with a strong support network
may be more likely to use it to assisting them in implementing adaptive coping strate-
gies (Folkman & Lazarus, 1990; Littleton & Radecki Breitkopf, 2006; Silver &
Wortman, 1980). Individuals with supportive relationships may also feel more confi-
dent in their ability to actively cope with the trauma (Littleton & Radecki Breitkopf,
2006; Silver & Wortman, 1980). In addition, survivors’ support networks may chal-
lenge their use of maladaptive strategies, reducing reliance on such strategies
(Littleton & Radecki Breitkopf, 2006; Silver & Wortman, 1980).
Limitations of the current study should be noted. The study involved a sample of
college rape victims and thus may not generalize to other populations of victims,
although it should be noted that the sample was fairly diverse with regard to age and
ethnicity. In addition, the results represent cross-sectional data, limiting our ability to
draw causal inferences. Indeed, it seems possible that there exist reciprocal relation-
ships among some of the variables in the model. For example, experiencing posttrau-
matic symptoms may lead to greater reliance on maladaptive strategies in coping with
the rape. In another example, unacknowledged victims who experience significant
and persistent distress may reconceptualize their experience as a victimization.3 Also,
although it is not a limitation per se, it should be noted that we used a broader con-
ceptualization of unacknowledged rape (those victims who did not conceptualize
their experience as a victimization) than did some prior research (i.e., victims who did
not label the experience a rape). We felt that what was key in defining acknowledg-
ment was whether women conceptualized their experience as a victimization rather
than whether they chose the specific label “rape” for their experience. Finally, we did
not examine a number of potential factors that could influence PTSD symptomatol-
ogy, such as previous trauma history, peritraumatic reactions, disclosure reactions,
resource loss, and trauma-related cognitions (e.g., the world is a dangerous place).
Despite these limitations, the results have important implications for future work.
Results indicate that unacknowledged victims can be traumatized by their experi-
ence, even though they do not conceptualize their experience as a victimization.
Results also suggest that differences in trauma symptoms between unacknowledged
and acknowledged victims may be accounted for in part by differences in assault
violence between these two groups. We believe that the results of this study suggest
that focusing on victims’ distress and trauma symptoms following rape should

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164 Violence Against Women

include both unacknowledged and acknowledged victims. Results also highlight the
potential role of coping in producing and perhaps maintaining PTSD symptoms fol-
lowing rape. In contrast, social support may act as a resiliency-promoting factor fol-
lowing rape, perhaps through its influence on victims’ coping. Thus, future work
should continue to focus on victims’ postassault experiences in evaluating predictors
of distress rather than focusing exclusively on characteristics of the assault. There is
also a clear need for longitudinal research evaluating the likely complex relation-
ships among assault factors, acknowledgment status, postassault experiences, and
distress among victims. Finally, there is a continued need for research focusing on
the experiences of diverse samples of rape victims.

Notes
1. Because likelihood ratio difference tests are not valid using the weighted least squares estimator,
we reran the models using robust maximum likelihood estimation to conduct the likelihood ratio differ-
ence tests.
2. It should be noted that although the weighted least squares estimator will produce correct estimates
using categorical data, it does sacrifice some information with respect to the continuous indicators.
Therefore, model fit will be worse with weighted least squares estimation than it would be under robust
maximum likelihood estimation.
3. Although procedures have been developed to test reciprocal relationships using structural equation
modeling, these models are notoriously difficult to estimate. Furthermore, the models we have presented
here provide a more direct test of our hypotheses and are consistent with previous research in the area.
Therefore, we decided not to report the results of such nonrecursive structural equation models.

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Heather Littleton is an assistant professor in the Department of Psychology at East Carolina University.
Her research interests span several areas related to women’s health including sexual victimization among
women, rape acknowledgment, coping and recovery following traumatic events, and body image.

Craig E. Henderson is an assistant professor in the Department of Psychology and Philosophy at Sam
Houston State University. His research interests encompass a broad range of topics, including family psy-
chology, substance abuse, and advanced data analytic methods.

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