*2.2. Sexual Assault and Intimate Partner Violence (IPV)*

In Women and Madness, Chesler raised the necessity of bearing witness as a mechanism for providing support to the victims of violence. Problematic perceptions and stereotypes about sexual violence can impact recognition and confidence that the survivor's experience is to be believed. The harm engendered through bystander apathy can be even more traumatizing for the survivor through its cacophonous silence. Chesler proposed more education, transformation and enforcement of victim centered laws, increased research on associated psychological trauma, and a political movement focused on human rights and self-esteem. When her book was reprinted in 2005, the introduction demanded change, reminding us that all too often the "active process of bearing witness inevitably gives way to the active process of forgetting" [2] (p. 37). A little over a decade ago, research estimated that between 50% to 80% of sexual assaults were committed by someone known to the victim, with a meager average of 15% of cases reported ever being prosecuted; at that point sexual assault within workplaces had been recognized as a public health crisis for more than 40 years with no industry or occupation immune to its occurrence [30].

Despite sounding the alarm decades ago, there is still much work to be done to address sexual violence and while it is not an issue that only affects women, the greater percentage of victims are women and groups that are marginalized. In 2018, a national representative study on sexual harassment and assault in the U.S. reported that within their lifetime, 81% of women had experienced some form of sexual harassment or assault, whereas only 43% of men had [31]. In terms of location, 38% of women had reported sexual harassment within the workplace and 35% of women reported interpersonal violence such as sexual assault within their residence [31]. Additionally, data showed greater percentages of sexual harassment and assault incidence based on disability status, sexual orientation, and racial/ethnic group [31]. These alarming statistics highlighted the imperative to, once again, acknowledge the prevalence of sexual assault and to engage in more action to prevent sexual violence in workplaces and in the home. Worldwide statistics are even more alarming. A 2018 analysis by the World Health Organization of data from more than 160 countries covering a timespan of nearly a decade found that 30% of women had experienced sexual or physical violence and nearly one in three women aged 15–49 reported having been subjected to either sexual or physical intimate partner violence [32].

As the world braced for the COVID-19 pandemic, quarantine policies and stay-athome orders were implemented, and as a serious consequence, the incidence of intimate partner violence (IPV) increased. During the pandemic and due to quarantining, victims of IPV, physical, psychological and sexual violence in the form of abuse or aggression within a current or former romantic relationship, were left trapped with their abusers. Reporting in the U.S. showed a 20% increase in calls related to IPV across 20 metropolitan cities, and global data showed an increase across several countries as well [26]. However, the economic impact and unemployment catalyzed by the pandemic created financial and psychological stressors that simultaneously increased the risk of occurrence of IPV while also reducing the potential for victims to seek help [33]. IPV rates still rose exponentially. Statistics indicate that IPV is found across all "races, cultures, genders, sexual orientations, socioeconomic classes and religions with one in four women and one in ten men experiencing IPV; however, such violence has a disproportionate effect on communities of color and other marginalized groups" [34] (p. 2302).

IPV has profoundly negative societal impacts as well as chronic health outcomes for the victims. Negative physical health outcomes may be associated with neurological, gastrointestinal and reproductive problems, and there is considerable comorbidity with mental health issues such as depression and post-traumatic stress disorder (PTSD) [33]. Furthermore, while there are complex mental health consequences associated with intimate

partner violence, PTSD is the most common [35]. Significant connections have also been found for women with SUD and profiles of comorbid PTSD caused by sexual or physical abuse trauma, compared to males with SUD [36]. Additionally, women with severe sexual abuse and emotional abuse profiles were found to significantly predict initiation of substance use. Childhood trauma exposure was also found to be associated with earlier use of substances [36]. The trauma profile of severe sexual abuse and emotional abuse is related to "more severe sociophobic symptoms, i.e., aspects of low self-confidence" and "a negative self-concept, including low self-confidence as typically seen in individuals with complex PTSD" [36] (p. 10). Within the U.S., close to three out of four women who experience severe forms of IPV are diagnosed with one or more mental health disorders, and those in substance use treatment programs also report increased occurrences of IPV [25]. Mason and O'Rinn's (2014) systematic review of research on the relationship between IPV and substance use disorder showed that the occurrence of sexual violence led to an increase in susceptivity to SUD through self-medication and psychological vulnerabilities, such as low self-esteem, depression, and anxiety [25].
