Male Disclosure of Sexual Abuse and Rape

Jennifer C. Yeager, MSc; Joshua Fogel, PhD


Topics in Advanced Practice Nursing eJournal. 2006;6(1) 

In This Article

Case Example: Tom Presents With Sleep Disturbances

Tom presents to his local clinic for help with problems associated with insomnia and reported difficulties in falling asleep, and once having fallen asleep, difficulty in remaining asleep for longer than 2 or 3 hours at a time. He also mentions experiencing frequent and violent nightmares, but he could not recall the content after awaking.

These sleep disturbances have been occurring for approximately 3 months and normally occur when Tom's roommates are not at home and he has gone to bed, feeling anxious about being in the house alone. Tom appears restless and constantly fidgets while talking.

Tom reports self-medication with alcohol in an attempt to "fall asleep a bit easier." He expresses a desire to decrease his current alcohol consumption. Use includes spirits (approximately 3 ounces), wine (approximately 15 ounces), and beer (approximately 48 ounces or 4 cans) in the form of binge drinking, normally while at home alone. Regular alcohol use started at age 16 years, but he reports that "my drinking wasn't out of control until these nightmares began." The last reported use was today. The rationale given for continued alcohol use is to forget his worries.

Tom reports that he has not previously been under the care of a mental health professional, and he has never before presented to a physician with sleeping problems. He is not currently taking any prescription medications.

Tom's case highlights some of the typical behavioral reactions to rape victimization that should raise red flags, which are listed in Table 1 . In this scenario, Tom is experiencing insomnia, nightmares, anxiety associated with being alone, and alcohol abuse. Although there may be multiple possible diagnoses or causes of Tom's behavior (eg, depression, insomnia), a history of possible sexual abuse must also be considered as a viable component in his current situation.

Therefore, at this point, the clinician should include sensitive questions that include the possibility of previous sexual abuse as a cause of behavior in the initial health and medical history. Ways to broach this issue are listed in Table 2 . For instance, a useful comment might be, "Tom, do you know of any reason that you might be experiencing these nightmares?" This question might then be followed up by asking, "Have you had an experience that is making you feel unsafe being home alone?"

The answers to these questions, accompanied by the clinician's judgment of the medical and health risks and needs, can be used to decide what management decisions are appropriate. For example, if Tom was in crisis, either as a result of disclosing his victimization or due to his psychological condition, immediate referral to a mental health professional would be necessary (again, highlighting the importance that a list of on-call professionals be available).

If Tom is in need of medical and/or psychological care but is not in crisis, it may be beneficial to provide initial treatment or referral. For example, medications to reduce anxiety or to deal with insomnia may be considered as a short-term solution until the patient obtains therapy to deal with the underlying psychological issues behind the insomnia and anxiety. However, these decisions must also be considered in terms of the patient's likelihood that he may abuse or become dependent on these medications (such as in the case of Tom, who has existing drug or alcohol abuse issues). Additionally, the patient can be provided with some additional support information, such as a list of support Web sites or literature (see Table 3 and Table 4 ), until he is referred to a mental health practitioner, if necessary.


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