Traumatisme psychique des victimes d’agressions sexuelles avec possible soumission chimique. Prise en charge UMJ

RésuméChaque année, de nombreuses personnes portent plainte pour agression sexuelle avec suspicion de soumission chimique. Les circonstances sont souvent les mêmes : un contexte festif avec une forte alcoolisation, puis une amnésie avec un réveil difficile et les stigmates d’une activité sexuelle. Les victimes attendent que l’examen effectué aux UMJ apporte la preuve de l’agression et de l’administration de produits à leur insu. Selon une étude menée aux UMJ de l’Hôtel-Dieu, dans la majorité des cas, seule l’alcoolisation massive est responsable des symptômes, ce qui entraîne un grand sentiment de culpabilité chez les plaignants. La plupart d’entre eux présentent une forte anxiété et des symptômes de psycho-traumatisme. La prise de conscience d’une certaine forme de responsabilité dans le déroulement des faits accroît leur désarroi. Chez les personnes rendues vulnérables par des antécédents traumatiques, le risque de passage à l’acte suicidaire peut être accru. Une prise en charge empathique et chaleureuse des soignants des UMJ, ainsi qu’une plus juste répartition des responsabilités peuvent aider à la reconstruction des personnes qui seront alors orientées vers les professionnels du réseau pour une prise en charge globale médico-psycho-sociale.

Many cases of Drug Facilitated Sexual Assault (DFSA) are reported every year. These assaults occur under similar circumstances: parties out with large consumption of alcohol followed by unconsciousness and traces of sexual activity on waking up. The victims expect the tests carried out in the forensic department (UMJ) to bring evidence that they have been drugged and sexually assaulted.Objectives of the studyThe aim of this study is to establish profiles of victims and perpetrators in order to gain better knowledge of the people concerned and to assess their mutual share of responsibility in the assaults. This study will provide health professionals with specialist knowledge of that type of post-traumatic disorder and help them adapt the way they care for the victims in order to avoid increasing the trauma and to facilitate healing.Materials & methodsThis prospective research was conducted over one year in the UMJ of the Hôtel-Dieu in Paris. The data concentrates on victims of sexual assault with a suspicion of drug-facilitation referred to the UMJ by the police. The victims taken into account are over-18 and French speaking. Three types of documents have been used: a medical report after clinical examination including all results of forensic drug analyses, a psychiatric report conducted by a psychiatrist sometimes after the assault, a questionnaire filled in by the victims attending serological follow-up appointments and interviews with specially-trained police officers.ResultsThe bulk of the victims are single women under 30 with no children. They are either students or young professionals. In most cases, forensic tests cannot establish evidence of sexual assault. When samples are collected within a few hours of the assault, toxicological tests establish excessive consumption of alcohol but cannot establish DFSA. Most victims are made to feel extremely anxious by this lack of evidence and tend to resort to alcohol to help them get over their feelings of shame and guilt. The perpetrators are males and are older than their victims. They come under two categories: the “opportunistic” assailant who waits for his victim to be incapable of resisting assault owing to excessive consumption of alcohol, the “proactive” assailant who looks out for vulnerable, intoxicated young women on the nightlife scene.ConclusionsWhat comes to the fore is that victims place themselves in a vulnerable position through alcohol intoxication and are then taken advantage of. They suffer from serious psychological trauma after being assaulted and their feeling of guilt is such that they sometimes refrain from asking for help. It is however obvious that although victims tend to make themselves vulnerable through excessive drinking, the responsibility for the assault remains totally that of the assailant. Compassionate care from UMJ staff and a fairer acknowledgement of the responsibility for the assault can kick-start the healing process. The victims are then given professional psychological and medical support.