Forensic Psychiatric Survey in Female Rape Victims
Victoria de la Caridad Reyes Ribot*, Victoria Gómez Sánchez and Elisa Isabel Montalvo Vidal
Department of de Peritación Mental, Instituto de Medicina Legal, Havana Cuba
Submission: July 16, 2019; Published:August 14, 2019
*Corresponding author:Victoria de la Caridad Reyes Ribot, Department of de Peritación Mental, Instituto de Medicina Legal. Avenida Independencia y Hernán Cortés. Havana Cuba
How to cite this article:Victoria de la Caridad Reyes Ribot, Victoria Gómez Sánchez, Elisa Isabel Montalvo Vidal. Forensic Psychiatric Survey in
Female Rape Victims. J Forensic Sci & Criminal Inves. 2019; 12(3): 555838. DOI: 10.19080/JFSCI.2018.11.555838.
In Forensic Psychiatry, the evaluation of victims is complex and requires an interdisciplinary approach. In the Institute of Legal Medicine, it is the women who have suffered rape, the victims who are most frequently evaluated. That is why a retrospective study was carried out with the aim of illustrating the forensic psychiatric expertise performed with each of them, as well as the main results obtained.
All the psychiatric expertise tests performed on rape victims evaluated in the Mental Perception Department of Havana from January 2016 to December 2018 were reviewed. Excluded were minors under 18 years of age and foreigners, so the sample was left conformed by 39 cases.
Among those evaluated, the ages between 18 and 29 years old, single and divorced, as well as students, predominated. The previous pathology that was found most frequently was the Mental Deficit. When performing the psychiatric examination, the symptoms that were detected mostly were anxiety and shame, fear and sadness. Post-traumatic stress disorder, a mental illness that is considered serious, was found in 46.2% of those evaluated.
Medical assessment in Cuba in criminal proceedings is regulated by articles 200, 205, 211, 332 and 334 and instructed by article 210 of the Criminal Procedure Act, by article 20 of the current Penal Code and by Ministerial Resolution No. 100 of 2008 , which provides that expert opinion may be available where, in order to know or assess any matter of importance in the case, scientific, technical artistic or practical knowledge is required; as well as providing for the establishment of a medical commission for forensic psychiatric expert training of subjects linked to judicial proceedings; it further approves and puts into force the methodology for the operation of the provincial commissions for forensic psychiatric practice in the national health system . The most important point of contact between Psychiatry and the law is the survey which attempts to clarify through a set of tests the mental state of a given subject by providing concrete scientific elements to the court on psychic phenomena investigating their personality [2,3].
In this context, the victim’s assessment is extremely complex, although much less treated in the literature than the figure of the
accused. Direct victims of crime are persons who, individually or collectively, have suffered damage, financial loss or substantial impairment of their fundamental rights, as a result of actions or omissions that violate the criminal law in force in the Member States; indirects victims are family members or natural persons in charge of the direct victim who have an immediate relationship with the victim and potential natural persons whose physical integrity or rights are at risk of providing assistance to the victim either for preventing or stop the violation of rights or the commission of a crime [4,5].
With several expert tasks to be fulfilled in the victim, the interdisciplinary approach is indispensable in all of them. In the case of sexual offences, this integration is of particular interest as the sum of the results of biological, toxicological, genital and physical examination, psychological evaluation, psychometric and psychiatric examination studies is the ideal route for answers to judicial questions concerning the psyche of victims at the time of criminal
In the practice carried out at the Institute of Legal Medicine,
are women who have suffered rape, victims most often are evaluated.
That is why the main objective of this research is to illustrate
the forensic psychiatric examination is done with each of them, as
well as the main results
A review study was carried out, in which all the department of
psychiatric expertise carried out to women victims of rape evaluated
in the Department of Mental Expertise in Havana from January
2016 to December 2018 were reviewed. The under-18s and
foreigners were excluded, so the sample was made up of 39 cases.
In all, the examination procedures, the personal history of the
victims, sociodemographic characteristics, the main symptoms
and signs detected, as well as the outcome of the evaluation were
The institution’s management and scientific council were requested
for authorization and data that could compromise the anonymity
of the victims were excluded.
In the 39 cases reviewed, the expert opinion included: accountability
of the victim’s personal history (including information
provided by the care physicians in which they received mental
health care), personal interview, interview with relatives (in
those with prior psychiatric pathology), psychiatric examination,
psychological evaluation (the selection of instruments was carried
out according to the psychopathological elements detected
in the interview; the most used being the Davidson Trauma Scale,
Machover Test, BSA and BDI), medical-legal analysis and conclusions.
Among those evaluated, the ages between 18 and 29 predominated
(51.3%), single women (41%) divorced (30.8%), as well as
students (35.9%) [Table 1].
The importance of specifying personal medical history is related
to the presence of psychiatric disorders that compromise
the mental capacity of the victim, which would place them in a
vulnerable situation and / or helplessness. Among the victims
assessed, the most commonly found previous pathology was the
Mental Deficit (43.6%) [Table 2].
During the psychiatric examination, the symptoms most detected
were anxiety and shame (56.4%), as well as fear and sadness
(51.3%) [Table 3].
After carrying out the survey, it was determined that 38.5% of
the victims did not have any psychiatric pathology of post-crime
installation. It should be noted that in these cases, these were victims
who had previous diagnoses of severe and moderate mental
retardation, as well as Schizophrenia; in which no affective trace
was found after the crime and some even had no recollection of
the occurrence of the crime. Post-Traumatic Stress Disorder, a serious
mental illness, was found in 46.2% of those evaluated. [Table
While the allegations of rape in Cuba do not compare with
those reported by other Latin American countries, it is a global
phenomenon from which the Caribbean island does not escape.
At the beginning of the 21st century there was sufficient data to
indicate that: ‘(...) up to 6 out of 10 women in the world experience
physical or sexual violence throughout their lives, and between
10% and 27% of women reported being sexually abused, including
girls or adults .
It is no wonder that it is younger women who most often suffer
sexual outrage; result in which our study coincides with the
literature consulted [7-9].
The existence of previous pathologies that compromise the
mental capacity of the victim, is related to the fact that this condition
places them in a position of helplessness such that, in most
cases it is not necessary that the abuser use extreme forms of coercion
to perpetrate the deed. In this regard, Oxman N . has
referred to the inability to resist or oppose the violation is subject
to the condition by the taxpayer of physical or mental, temporary
or permanent impairments that limit themselves in an absolute
way the possibilities of coping with sexual assault. The authors
believe that not only should take into account the ability to object,
but also the ability to recognize aggression.
The presence among the victims of Post-Traumatic Stress
Disorder (PTSD) was an expected result, taking into account
the clinical findings in the psychiatric examination and the high
prevalence of this condition in the population studied. Ventura
Velázquez RE  notes that more than 50% of women who have
been victims of rape can develop this type of disorder.
It is important to note that the emergence of this pathology
is not only due to the traumatic event alone, but also to vulnerability,
genetics, environmental factors and sociocultural level
. Although, PTSD has still been categorized as a psychological
disorder since 1980, in recent years research has attempted to
understand the origins of the disorder at the biomolecular level
Due to the marked impact on the quality of life that this entity
represents, it is considered a serious mental illness, which has an
impact on the sanctioning framework of the aggressor.
Therefore, an early and successful therapeutic approach is
indispensable. By impact on emotional life, if PTSD is not properly
treated may evolve into permanent deterioration in individual
and social functioning [16,17].
Various approaches to psychotherapy, such as the one based
on exposure seem effective in treating PTSD, in addition to the
pharmacotherapy, which should consider concomitant tables
many times such as depression, addictions, chronic pain and
generalized anxiety. The sertraline and paroxetine are two drugs
approved in the United States for PTSD, as they were associated
with fewer symptoms, but at 70 to 80% there are no complete
answers. The pharmacotherapy combination with psychotherapy
was linked to better results, possibly by stimulating extinction of
traumatic memories and the prevention of fear incubation .
Several authors argue that prolonged exposure and training
of stress inoculation are highly effective techniques for treating
symptoms [19-21]. Others consider that if the intervention is almost
immediate, after the significantly reduce the risks of chronicity
post-traumatic [11,22]. Caro Haces and collaborators 
propose psychotherapy with integrative approach as the most effective
method in the treatment of PTSD.
In the field of forensic psychiatry, it is of extraordinary value
that the successful determination of PTSD, because of the legal repercussions
that can have rigged. Regardless of the diagnosis, it is
important to recognize that sexual assault is an event that causes
in most victims a series of alterations and consequences that seriously
compromise mental health .
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