BACKGROUND:Several distal and proximal processes have been implicated in sexual aggression (SA) perpetration, including sexual misperception, or the erroneous perception of a potential partner's sexual interest or consent, alcohol intoxication, and past perpetration. Little is known about how these predictors interact in the context of a sexual interaction. Thus, the present study aimed to investigate how men's perceptions of a woman's sexual interest changed over the course of a hypothetical sexual interaction and how their intoxication, past perpetration and the woman's consent cues influenced those perceptions. METHODS:Single, male social drinkers aged 21-30 with a history of risky sexual behavior (N = 97) completed an alcohol administration paradigm in which they were randomly assigned to an alcohol condition (sober control vs. intoxicated [BrAC = 0.10%]). Participants read a hypothetical scenario in which a man and woman engaged in nonpenetrative sex and the woman expressed nonconsent nonverbally and verbally. At several points during the scenario, participants rated the woman's sexual interest. Participants also reported their past perpetration. RESULTS:Men's perceptions of the woman's sexual interest significantly decreased following verbal expressions of nonconsent. There were no significant differences between intoxicated and sober participants' ratings of the woman's sexual perception following verbal expressions of nonconsent. Men with a history of perpetration rated the woman's sexual interest following multiple verbal expressions of nonconsent as higher than nonperpetrators. CONCLUSIONS:Results suggest that intoxication does not necessarily impede men's ability to adjust their perceptions of a woman's sexual interest following verbal expressions of nonconsent.

Objective: The present study aimed to compare post-traumatic stress symptom (PTSS) severity for three victimization profiles: childhood sexual abuse (CSA)-only, adulthood sexual assault (ASA)-only, and CSA + ASA. Additionally, the study examined the role that resilience variables–mindfulness and emotion regulation–play in the association between victimization timing and PTSS severity.Method: Participants were 247 cisgender community women aged 21-30 recruited for a larger study on high-risk drinking and sexual behaviors. Victimization history was assessed using the Computer Assisted Maltreatment Inventory and Sexual Experiences Survey-Revised. PTSS severity was measured with the PTSD Checklist for DSM-5. Emotion regulation and mindfulness were evaluated using the Difficulties in Emotion Regulation Scale-36 and Southampton Mindfulness Questionnaire, respectively. Negative binomial regression models tested the hypotheses.Results: Analyses revealed significant differences in PTSS severity by victimization timing: CSA + ASA was associated with the greatest PTSS severity, followed by ASA-only, and CSA-only reporting the lowest severity. Mindfulness and emotion regulation were directly associated with reduced PTSS severity across all victimization profiles. Conclusions: Revictimization was linked to the most severe PTSS, underscoring the need for targeted interventions. Mindfulness and emotion regulation were associated with reduced PTSS severity, regardless of victimization timing. Future interventions could prioritize enhancing psychological skills, like mindfulness and emotion regulation, to reduce distress for victim-survivors of sexual victimization.

Several robust predictors of men's sexual aggression perpetration include components of the confluence model, specifically alcohol consumption and constellations of attitudes referred to as hostile masculinity and impersonal sex. These constructs have also been found to predict sexual misperception, a frequent intermediary for sexual aggression, and coercive condom use resistance. Whether alcohol and hostile masculinity and impersonal sex operate independently or in concert to increase the likelihood of male sexual aggression perpetration and these related behaviors is unclear, and prior studies produced mixed findings. To address these knowledge gaps, we reviewed empirical studies that examine the impact of associations between alcohol and hostile masculinity and alcohol and impersonal sex on sexual aggression perpetration, sexual misperception, and coercive condom use resistance by men. We identified 19 studies of undergraduate and community men. There was support for a shared pathway from alcohol use and impersonal sex to sexual aggression and misperception, although potential causal mechanisms remain untested. There was limited evidence that alcohol intoxication interacts with hostile masculinity to predict sexual aggression perpetration, but further studies are needed to replicate and extend these findings. Critical gaps include limited studies of sexual misperception and condom use resistance and limited testing of competing hypotheses.

Sexual aggression (SA) perpetration poses a significant threat to public health and safety. Despite increased attention toward prevention of SA perpetration, empirical research and prevention programming have focused primarily on perpetration by cisgender men against cisgender women. This heteronormative framework neglects the needs of non-heterosexual populations who experience elevated rates of SA victimization and likely compounds existing inequities in mental health outcomes and access to care.ObjectivesTo address this critical gap, this study presents a narrative review of the quantitative literature on SA perpetration in non-heterosexual populations.MethodThis narrative review identified seven quantitative studies on SA perpetration in LGBQ populations and (a) describes the methodology across studies, (b) describes the demographics across studies, and (c) summarizes prevalence rates and risk factors.ResultsThere was a reasonable degree of consistency in the studies' measurement of SA perpetration. Differences included the specific measure, victim gender, and classification systems for SA. The samples identified were exclusively from wealthy, Western, industrialized nations and were predominantly White. Perpetration rates varied by gender and sexual orientation and classification system. Identified risk factors included variables related to early adverse events, sexuality and gender roles, aggression, and substance use.ConclusionFindings demonstrate that SA perpetration is not a public health problem exclusive to heterosexual individuals and that LGB populations would benefit from the development of etiological models and evidence-based intervention. Future research should attempt to replicate and extend findings, particularly among more diverse samples.

Women who have experienced childhood sexual abuse (CSA) or adolescent/adult sexual assault (ASA) are at a heightened risk of acquiring sexually transmitted infections (STIs) and demonstrate lower rates of condom use than women who have not had these victimization experiences. Two understudied factors that may help explain these associations are sexual relationship power and sexual assertiveness for condom use. In this secondary data analysis study, we evaluated whether CSA and ASA severity were related to less frequent condom use through experiences of lower power in sexual relationships with men and lower sexual assertiveness for condom use. Women ( N = 770) who reported STI risk factors and moderate social drinking were recruited from an urban community. Participants presented to a laboratory and completed a questionnaire battery on a computer as part of the larger study. Path analyses revealed that CSA and ASA were indirectly associated with a lower frequency of condom use through lower sexual relationship power and lower sexual assertiveness for condom use. Findings suggest that women's condom use frequency may be increased through interventions that prioritize decreasing power imbalances in sexual relationships and enhancing women's abilities to assertively request condom use, particularly among those with CSA and/or ASA histories. We conclude that trauma-informed interventions that enhance women's assertiveness and agency, address relational power imbalances, and involve male partners, alongside broader public health and policy efforts to promote women's social and economic power, are crucial for advancing shared responsibility for women's sexual health.

Alcohol's link with sexuality is long-standing and prominent. While research continues to document robust associations between drinking and sexual behavior, attention now centers primarily on evaluating mechanisms and attendant theoretical frameworks to advance our understanding of how alcohol exerts a causal impact. We describe four domains with reliable evidence of alcohol effects: sexualized social perceptions, sexual arousal, sexual risk taking, and sexual assault. We consider three contextual frames: distal factors associated with encountering opportunities for alcohol-involved sex, proximal factors associated with alcohol's acute effects, and distal–proximal interactions. We then examine the empirical support for mechanisms embedded within four theoretical frameworks: alcohol disinhibition, alcohol expectancy, alcohol myopia, and emotion regulation. Support for disinhibition mechanisms is evident with sexual arousal only. Expectancy and myopia mechanisms enjoy support across domains and make up bases for integrative expectancy–myopia causal explanations. Emotion regulation mechanisms evidence preliminary support in risk taking and sexual assault. Implications and future directions are considered. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Understanding the mechanisms underlying sexual aggression perpetration is critical for the development of targeted, evidence-based prevention. The current study evaluates the effects of state emotion regulation (ER), acute alcohol intoxication, and Confluence Model constructs on sexual aggression perpetration intentions. Single, male social drinkers, aged 21-30 years, with a history of sexual risk-taking (N = 90) were randomly assigned to an alcohol (BrAC = 0.1%) or sober control condition and completed measures of hypothetical sexual aggression intentions, state ER, and Confluence Model constructs. Logistic regression demonstrated men high in hostile masculinity expressed significantly greater sexual aggression intentions. In addition, men with poor state ER endorsed significantly greater sexual aggression intentions, although this relationship only held for the men in the sober condition. Results suggest that interventions targeting state ER may be beneficial to sexual aggression perpetration prevention programming.

Young adult women report high condom use intentions, but inconsistent condom use. Cognitive appraisals during sexual encounters are important determinants of condom use decisions, but a nuanced understanding of what cognitions emerge during women's "hot states" (e.g., sexual arousal, alcohol intoxication) remains lacking. To address this gap, we examined women's heat of the moment cognitions in their own words using mixed methods. Young adult women (N = 503; Mage = 25.01, SDage = 2.66) were randomized to a beverage condition (alcohol or control), then read and responded to questions about an eroticized sexual scenario. The nature and strength of reasons for and against having sex were reported before and after learning no condom was available. Multilevel models revealed intoxicated participants were more likely to let the partner decide how far to go sexually than sober participants at both timepoints, but the strength of cognitive appraisals (reasons for, reasons against, and feeling conflicted) only differed between beverage conditions after knowledge of no condom. These results suggest alcohol myopia was evident in the presence of inhibition conflict. Content analysis of these reasons revealed multifaceted cognitions that changed upon learning there was no condom. Findings highlight cognitions to target through interventions and underscore the importance of both alcohol and situational context in decision making.

Objective: Decades of research have been dedicated to the study and prevention of sexual aggression perpetration. Despite robust evidence linking acute intoxication and sexual aggression perpetration, few studies have examined this association in naturalistic contexts like drinking settings. Field studies are needed to inform etiological models and interventions that generalize to the naturalistic environment. The goal of this study is to guide researchers on the logistical and ethical considerations involved in conducting an alcohol field study by detailing the methodology used in a field study on alcohol and sexual misperception. Method: This article presents a field study protocol for measuring sexual misperception, a precursor to sexual aggression, in patrons exiting bars. One hundred forty-three participants completed the study procedures. Results: In-depth information on procedures for site selection, recruitment, screening, measure selection, consent, and capacity assessment is provided. Ethical considerations, barriers to the implementation of field studies, and possible solutions are discussed. Conclusions: Field studies can evaluate proximal causes of alcohol-involved sexual aggression and intermediary processes like sexual misperception in naturalistic settings. Greater implementation of field studies is required for a comprehensive understanding of alcohol-involved sexual aggression perpetration and generalizable interventions.

Objective: The present study aimed to compare post-traumatic stress symptom (PTSS) severity for three victimization profiles: childhood sexual abuse (CSA)-only, adult sexual assault (ASA)-only, and CSA + ASA. Additionally, the study examined the role that resilience variables–mindfulness and emotion regulation–play in the association between victimization timing and PTSS severity.Method: Participants were 247 cisgender community women aged 21-30 recruited for a larger study on high-risk drinking and sexual behaviors. Victimization history was assessed using the Computer Assisted Maltreatment Inventory and Sexual Experiences Survey-Revised. PTSS severity was measured with the PTSD Checklist for DSM-5. Emotion regulation and mindfulness were evaluated using the Difficulties in Emotion Regulation Scale-36 and Southampton Mindfulness Questionnaire, respectively. Negative binomial regression models tested the hypotheses.Results: Analyses revealed significant differences in PTSS severity by victimization timing: CSA + ASA was associated with the greatest PTSS severity, followed by ASA-only, and CSA-only reporting the lowest severity. Mindfulness and emotion regulation were directly associated with reduced PTSS severity across all victimization profiles. Conclusions: Revictimization was linked to the most severe PTSS, underscoring the need for targeted interventions. Mindfulness and emotion regulation may facilitate recovery by alleviating PTSS severity, regardless of victimization timing. Future interventions should prioritize enhancing psychological skills, like mindfulness and emotion regulation, to reduce distress for victim-survivors of sexual victimization.

Objective: Women with sexual assault (SA) histories report heavier and more frequent drinking. Consistent with the motivational model of alcohol use, women with SA histories may consume alcohol to both downregulate negative emotions and upregulate positive ones. The present event-level study used a Bayesian multilevel moderated mediation approach to examine the extent to which women's alcohol use and intoxication was influenced by coping and enhancement drinking motives to downregulate or upregulate affect, respectively. Method: Women ages 21-30 were recruited from the community to participate in a larger study that included a 32-day daily diary assessment of affect, drinking motives, and alcohol use. Results: We found consistent support for women's tendencies to be motivated to drink to cope or enhance negative or positive affect, respectively, and those drinking motives were associated with indicators of increased drinking. Becoming intoxicated to downregulate negative emotion was common and this pathway was particularly strong for women who reported more severe SA histories. Although women with more severe SA histories were generally more likely to drink more, they were not likely to do so as a way to enhance positive experiences. Conclusions: Alcohol interventions that provide adaptive regulatory strategies are needed for women who experience increased negative or positive affect, with a particular focus on self-medication for young women with more severe SA histories. Clinical Impact Statement Results of the present study suggest that becoming intoxicated to cope with negative emotion is common among women with severe sexual assault histories. Although women with more severe SA histories were generally more likely to drink more, they were not likely to do so as a way to enhance positive experiences. Interventions to reduce alcohol consumption and associated intoxication levels that provide adaptive regulatory strategies are needed for young adult women with increased negative or positive affect.

Sexual aggression remains a significant public health concern, and alcohol intoxication is a key contributor to its occurrence. Despite its prevalence and harmful consequences, interventions addressing the specific mechanisms underlying alcohol-involved sexual aggression are lacking. In the present chapter, we argue that an experimental medicine approach to identifying, measuring, and targeting postulated mechanisms contributing to sexual aggression would enhance these intervention efforts. To that end, we review the extant research on sexually aggressive behavior, focusing on key cognitive, physiological, and emotional mechanisms. Within each of these areas, we examine the research regarding alcohol’s relationship to the mechanism as well as the existence and effectiveness of interventions targeting said mechanisms. Finally, we present as an exemplar a study that used an experimental medicine approach to investigate the utility of targeting emotion regulation as a mechanism underlying alcohol-involved sexual aggression, with additional suggestions for other novel investigations utilizing this paradigm. We conclude that by capitalizing on both new and established rigorous experimental methods, researchers can identify and target the mechanisms of behavior change underlying alcohol-involved sexual aggression, thereby increasing the effectiveness of sexual aggression prevention and intervention programs.

This study assessed the role of mental health symptoms and motives for sex in the association between childhood sexual abuse (CSA) and sexual risk-taking among men who have sex with women (MSW). The sample consisted of young adult (ages 21 to 30), non-monogamous MSW (N = 532) who reported having condomless sex at least once in the past year. Due to alcohol-related aims from two larger studies from which the data were analyzed, participation was excluded to men who regularly consumed alcohol (3 to 35 weekly drinks) and reported no symptoms of alcohol use disorder. Participants answered background questionnaires in lab and then completed a six-week, follow-up survey assessing the number of sex partners and condom use during the prior six weeks. CSA survivors reported greater mental health symptoms and sex motives related to coping, self-affirmation, and partner approval relative to non-survivors. CSA, sex for partner approval, and sex to enhance motives were positively associated with the number of sex partners. Participants endorsing self-affirmation sex motives reported higher condom use than those who did not. CSA contributes to long-term mental and sexual health outcomes among MSW. Identifying and treating depressive and anxiety symptoms and motives for sex may improve sexual health among CSA survivors.

Partner violence (PV) among Asian American women is a significant problem, with a reported lifetime prevalence of 16–55

Intimate partner violence (IPV) perpetration increases throughout young adulthood and is particularly widespread among college students, resulting in mental health and academic consequences. Deficits in emotion regulation (ER) are an important factor associated with IPV perpetration; the developmental tasks and challenges associated with college, including relationship stressors and hazardous alcohol use, implicate ER as a particularly relevant risk factor for IPV perpetration. Thus, college presents an important opportunity for intervention in order to change the trajectories of IPV perpetration across young adulthood. The purpose of this review was to synthesize findings regarding ER and psychological, physical, and sexual IPV perpetration among college students. Twenty-one articles met inclusion criteria. Studies were organized into five categories: (a) direct associations of ER with IPV perpetration, (b) qualitative assessment of ER and IPV, (c) ER in indirect effects models, (d) ER in moderation models, and (e) experiments with ER instructional sets. Overall, ER emerged as an important inhibiting factor for IPV perpetration, particularly impulse control and access to ER strategies. ER deficits in the context of impelling (e.g., negative affect, trauma history) and instigating (e.g., provocation) factors emerged as consistent predictors of psychological and physical IPV perpetration for both male and female students. Deficits in ER were associated with sexual IPV perpetration among men; however, very few studies examined sexual IPV. Experimental paradigms suggest cognitive reappraisal may reduce IPV perpetration, while suppression may, in some contexts, increase perpetration. Methodological strengths and weaknesses and implications for IPV prevention and interventions programming for college students are discussed.

The problem of alcohol-involved sexual assault against women highlights the need to identify how the presence of alcohol interacts with risk factors associated with sexual assault perpetration. One risk factor for sexual assault perpetration is fear of intimacy, the inhibited capacity to exchange vulnerable thoughts and emotions with a valued individual. Men who have perpetrated sexual violence report higher fear of intimacy and alcohol use than those who have not. However, little research has investigated how fear of intimacy may contribute to sexual assault perpetration in the context of alcohol intoxication. This study examined alcohol intoxication, fear of intimacy, proximal power-related emotions, and nonconsensual sex intentions. Non-monogamous, male social drinkers (N = 94) completed measures and were randomly assigned to an alcohol condition (alcohol [BrAC = .10%] versus control). Participants then read a sexual assault analogue scenario depicting sexual assault against a hypothetical woman and reported power-related emotions and nonconsensual sex intentions. Self-reported fear of intimacy differed across types of past perpetration. Results found that for intoxicated men only, fear of intimacy was positively associated with power-related emotions, and power-related emotions were positively associated with nonconsensual sex intentions. These associations were not observed for men in the control condition who did not consume alcohol. Future research should examine intimacy-related interventions for sexual assault prevention programming.

Adult sexual assault (ASA) in college remains a concern. Consequently, many college-aged women experience negative emotions surrounding sexual activity (sex-related distress). Consistent with self-medication theory, some drink to cope with sex-related distress, which may reduce distress, but lead to greater drinking quantity before sex and negative sexual consequences. How women with ASA histories navigate sexual situations and cope with sex-related distress is under researched. We examined ASA, sex-related distress, and drinking to cope motives to understand correlates of drinking before sex. First and second year college women (n = 300) reported on a recent sexual experience in the past six weeks. In the full sample, ASA severity was associated with a greater likelihood of drinking before sex, while general sex-related distress was associated with a lower likelihood. General sex-related distress was associated with event-specific sex-related distress and sexual consequences. There were no differences in number of pre-sex drinks or subjective intoxication during sexual activity based on ASA. In a subsample of women who drank before sexual activity (n = 179), drinking to cope with sex-related distress motives mediated the association between sex-related distress and sexual consequences. Interventions can draw on these findings to target self-medication drinking in consensual sexual situations.

Condom use resistance (CUR) remains a significant problem, and many men employ coercive CUR strategies to avoid using condoms with partners who do not consent to unprotected sex. To assess the decision-making process underlying men's coercive CUR, the present study administered alcohol to assess the effects of alcohol intoxication, condom request style, and emotion regulation (ER) strategies (i.e., cognitive reappraisal, expressive suppression) on intentions to use coercive CUR to have unprotected sex during a hypothetical sexual scenario. Sexually active, male social drinkers (N = 297) were randomly assigned to either consume alcohol or remain sober, and to project themselves into a hypothetical sexual scenario during which they received either indirect, direct, or insistent condom requests. Results showed that, although cognitive reappraisal had no relationship with coercive CUR or unprotected sex intentions, expressive suppression's relationship with intentions to have unprotected sex was mediated by coercive CUR and moderated by alcohol intoxication and condom request. Specifically, suppression was positively associated with coercive CUR among sober individuals who received an indirect condom request only. Such results suggest that sober men with suppressive tendencies may use coercive CUR to regulate negative emotions, such as frustration at not being able to have unprotected sex.