A 26-year-old graduate student comes to the campus medical clinic with a report that she was raped after a dinner date 5 weeks ago. The patient tearfully describes details of the incident and acknowledges that she did not report it to the police because she was concerned that her parents would pull her out of college. She recently confided in a friend, who encouraged her to seek medical care. The patient is now concerned that she might be pregnant or have a sexually transmitted disease. Since the assault, she has had recurring nightmares of the rape and takes the long way to class so that she does not walk past the man's apartment where the rape occurred. Occasionally, she will hear her assailant's voice or feel his breath on her face. It takes the patient almost an hour to fall asleep, and she is afraid to be alone. In addition, she has extreme difficulty concentrating in class and would rather not attend at all despite previously enjoying school. This patient is at greatest risk for developing which of the following?

Question

A 26-year-old graduate student comes to the campus medical clinic with a report that she was raped after a dinner date 5 weeks ago.  The patient tearfully describes details of the incident and acknowledges that she did not report it to the police because she was concerned that her parents would pull her out of college.  She recently confided in a friend, who encouraged her to seek medical care.  The patient is now concerned that she might be pregnant or have a sexually transmitted disease.  Since the assault, she has had recurring nightmares of the rape and takes the long way to class so that she does not walk past the man's apartment where the rape occurred.  Occasionally, she will hear her assailant's voice or feel his breath on her face.  It takes the patient almost an hour to fall asleep, and she is afraid to be alone.  In addition, she has extreme difficulty concentrating in class and would rather not attend at all despite previously enjoying school.  This patient is at greatest risk for developing which of the following?

Quizplus · Accepted Answer

This patient's exposure to a life-threatening, traumatic event and a 5-week history of recurrent nightmares, intrusive memories, avoidance, hyperarousal, and impaired concentration are consistent with post-traumatic stress disorder (PTSD). post-traumatic stress disorder (PTSD) Research most strongly supports that in addition to PTSD, sexual assault victims are at increased lifetime risk for major depression and contemplation of suicide or actual attempts. These patients are also at increased risk for medical problems, including sexually transmitted disease, pelvic pain, fibromyalgia, functional gastrointestinal disorders, and cervical cancer (which may be linked to an avoidance of pelvic examinations). (Choice A) In avoidant personality disorder, social interactions are avoided due to a sense of inadequacy and concern about negative evaluation. This pattern of avoidance is pervasive across settings and already evident by early adulthood. (Choice B) Borderline personality disorder (BPD) is characterized by a lifelong pattern of unstable interpersonal relationships, emotions, and self-identity through a range of contexts. Patients with BPD often have a history of trauma or abuse; however, symptoms of the disorder will have already manifested by early adulthood. (Choice C) Victims of assault often have panic-like symptoms (eg, pounding heart, rapid breathing) when confronted with reminders of their trauma and may occasionally develop panic disorder, which manifests in additional, unexpected panic attacks. However, there are stronger links between sexual assault and PTSD, depression, and suicidal ideation. (Choice D) Although trauma can worsen preexisting psychosis, the new onset of persecutory delusions following trauma is uncommon. Patients with trauma may experience hallucinations, which are part of the dissociative experience of a flashback, rather than an independent psychotic process. Educational objective: Patients who experience sexual assault are at high risk for developing post-traumatic stress disorder, depression, and suicidality. References: Sexual assault victimization and psychopathology: a review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/28689071) Gynecological symptoms associated with physical and sexual violence. (http://www.ncbi.nlm.nih.gov/pubmed/18821266) Risk for mental disorders associated with sexual assault: a meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/30585128)

A 26-Year-Old Graduate Student Comes to the Campus Medical Clinic