(PS13-D77) Adult Inpatients' Reports of Implausible Sexual Assault Occurring During Sleep: A Case Study

INTRODUCTION: Psychiatric inpatient settings are high-risk sites for sexual assault (SA). Investigations of alleged SA are compounded by challenges, including the presence of strongly held beliefs that alter perceptions of reality despite evidence to the contrary (i.e., delusions), which are common among individuals experiencing psychosis. Such symptoms of severe mental illness may affect the plausibility of the alleged SA. An under-researched phenomenon is inpatients reporting implausible SA having occurred during sleep. Such reports are alarming and reasons for inpatients’ perception of this event are not well understood. Given the efficacy of cognitive behavioral therapy for psychosis (CBTp), further research is necessary to understand this phenomenon and inform treatment considerations for responding to inpatients’ reports of implausible SA occurring during sleep. Therefore, we conducted a case-series study of inpatients who reported implausible sexual assault occurring during sleep to (1) examine rates of occurrence and (2) factors associated with this reported experience.

METHOD: Hospital staff provided referrals for eligible, adult inpatients who reported SA occurring during sleep. Retrospective chart review was used to gather information, including demographics and details of reported SA, and to assess severity of psychosis presentation via an abbreviated Positive and Negative Syndrome Scale (PANSS-6), which was scored by investigators. Consistent with case-series design, data were visually inspected.

RESULTS: At present, 4 participants (50% White; 75% female) that alleged SA were recruited, with an average age of 34 (SD = 9.54). Investigations into alleged SA (e.g., review of hospital video recordings) did not substantiate SA allegations. Among other results, findings indicate several systematized delusional beliefs that influenced behavior (moderate to severe severity), manic-like symptoms, trauma history, themes of decreased safety, and conceptual disorganization. Notably, the presence of auditory hallucinations and negative symptoms (e.g., anhedonia, flat affect) were minimal. There was variability in the number of alleged SA events reported, identification of an alleged perpetrator, and perceptions of why they thought the SA occurred (e.g., detection of odors).

CONCLUSION: To our knowledge, this was the first study to examine factors associated with inpatients’ reports of implausible SA occurring during sleep. Results indicate daytime delusions, elevated mood, trauma history, decreased sense of safety, and disorganized thought processes were common presentations among inpatients alleging implausible SA during sleep. While additional research is required, aforementioned symptomatology may indicate individual risk factors that may be amenable to CBT-based interventions (e.g., CBTp) to reduce inpatients’ perception of implausible SA. Limitations include reliance on retrospective chart review. Future research should examine prospective allegation of implausible SA during sleep among inpatients; the authors are currently recruiting for prospective research.