Abstract
Background
Sexual violence can cause severe mental and bodily harm. This is the first study of a population-based sample in Germany to assess both the frequency of the subjects’ having experienced sexual violence and the frequency of their having manifested sexually aggressive behavior themselves.
Methods
2513 persons (of whom 2422 were over age 18 and 91 were aged 14 to 18) were asked about their experiences with sexual violence in the past 12 months, either as the person committing sexual violence or as the victim of sexual violence at the hands of other adults or similarly aged adolescents.
Results
0.6% (n = 6) of the men and 1.2% (n = 16) of the women surveyed, and ca. 5% (n = 4) of the adolescents surveyed, reported having been the victim of some kind of sexual violence. 1.5% (n = 15) of the men and 1.0% (n = 13) of the women reported that they themselves had manifested sexually aggressive behavior. Women were overrepresented and adolescents underrepresented in the sample, in comparison with the overall population.
Conclusion
These findings suggest that the prevalences of experiences of sexual violence and of sexually aggressive behavior are markedly underestimated in official crime statistics, particularly with respect to events in which women commit sexual violence and men are victims of it. Prevalences were assessed in this study from self-reported information; the findings may thus have been distorted by a tendency on the part of the informants to give answers they thought would be socially acceptable, particularly with respect to their own sexually aggressive behavior. Moreover, the small overall number of events complicates the interpretation of the findings.
In recent years, studies of the prevalence of sexual violence have mainly concentrated on child abuse (1), with far fewer studies of sexual violence in adults or in adolescents (i.e., committed by adolescents against adolescents). Nonetheless, sexual violence in adults or adolescents causes severe mental and bodily harm, just as child abuse does (2, 3), even if it is only rarely reported to physicians or to the criminal justice authorities (4). In the present study, we aim to estimate the frequency of these types of sexual violence with the aid of a representative population sample, and thereby to sensitize physicians to this important problem. We determined not only the frequency with which the subjects reported having been the victims of sexual violence, but also their self-reported frequency of having manifested sexually aggressive behavior themselves.
In an earlier representative survey conducted in Germany on the topic of sexual violence, 2.4% of women and 0.3% of men reported having been the victims of sexual violence in the past 5 years. The sample (n = 11 428; 51.9% female) consisted mainly of persons aged 16 to 40 (mean age, 27.04 years) (5). In a further study that included only women (n = 10 264) aged 16 to 85, 12.8% of the respondents reported having experienced sexual violence at least once since age 16, in the sense of being forced to engage in sexual activity (including only attempted sexual compulsion) (6). There have not been any population-based studies on the frequency of sexually aggressive behavior among adults in Germany. One study has dealt with the frequency of experienced sexual violence among adolescents in Germany; it was based on a questionnaire among ninth graders (n = 44 610). 1.8% of the girls and 0.4% of the boys reported having participated in sexual activity under the threat of violence, or the application of actual violence, in the preceding 12 months. It was not stated whether the persons committing these acts were adults or adolescents. Moreover, 0.3% of the girls and 2.6% of the boys stated that they had, at some time, manifested sexually aggressive behavior toward others (7).
The variable periods of observation in these studies make their findings difficult to compare with official criminal statistics, which are always based on individual years. According to the statistics for 2014, for example, 12 742 persons (93.3% female) were the victims of attempted or completed violations of sexual autonomy involving the application of force or the exploitation of a dependency relationship (8). The reported age-specific and sex-specific distributions of victims and suspects in crimes against sexual autonomy are given in Table 1 (9). Such tallies naturally include only those crimes that come to the attention of the police and thus systematically underestimate the real frequency of sexual violence, because many such events never result in an official complaint. Victims of sexual violence often refrain from reporting the event out of shame, or out of a failure to realize that a crime has been committed; sometimes, sexual violence can be of a type that does not fall under the official definition of any crime and thus cannot be officially registered as such (5). It is thought that only 5–25% of sexual offenses give rise to an official complaint (2).
Table 1. Sexual violence in Germany: official statistics on the frequency of being a victim or a suspect against whom a complaint is made, 2014*1.
| Age 14–17 years | Age 18–20 | Age 21 and older | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Both sexes | Male | Female | Both sexes | Male | Female | Both sexes | Male | Female | |
| Frequency of being a victim*2 (expressed as number per 100000 individuals and as a percentage) | 98.3 (0.098%) |
14.2 (0.014%) |
186.9 (0.187%) |
76.3 (0.076%) |
9.3 (0.009%) |
147.3 (0.147%) |
11.1 (0.011%) |
1.2 (0.0012%) |
20.2 (0.02%) |
| Frequency of being a suspect against whom a complaint is made*3 (as n/100000 and as a percentage) | 28.2 (0.028%) |
53.9 (0.054%) |
1.2 (0.001%) |
35.3 (0.035%) |
68.0 (0.068%) |
0.9 (0.001%) |
9.4 (0.009%) |
19.3 (0.019%) |
0.3 (0.0003%) |
*1According to crime statistics of the police in Germany, 2014 (9), for attempted or completed crimes against sexual autonomy with the use of violence or exploitation of a dependency relationship, e.g., exploitation of an official position or a therapeutic relationship, or abuse of a minor under one’s charge (§§ 174, 174a, 174b, 174c, 177, 178 StGB)
*2Victims per 100000 population of the same sex and age group; also expressed as a percentage (in parentheses)
*3Suspects per 100000 population of the same age group; also expressed as a percentage (in parentheses)
Methods
Description of the sample
A sample of the German population that was representative with respect to age, sex, educational level, and region of residence was generated by a demographic institute (USUMA, Berlin) by a random-route process with a given starting address. On the basis of a given street name and house number, the survey personnel identified and contacted every third household, with the goal of conducting an interview. In the 4902 households that were contacted in this way, the interview partners were chosen at random. The inclusion criteria were that all informants had to be at least 14 years old and speak German well enough to participate. 2576 interviews were carried out. The main reasons for non-participation of households in interviews were the following:
No establishment of contact with household, despite four visits (n = 671)
The household declined to provide information (n = 710)
No establishment of contact with target individual, despite four visits (n = 95)
The target individual declined to be interviewed (n = 749).
63 interviews could not be evaluated. As a result of the study design, no demographic information is available about persons who chose not to participate in the study.
The persons to be interviewed were visited personally by the survey workers (interviewers). The interviewers explained the nature of the study and obtained the respondents’ informed consent. When explaining the nature of the study, they did not identify any specific topic of interest, instead stating generally that the study concerned mental health and well-being. Accordingly, the data obtained in fact concerned not only sexual violence, but also mental stress, various experiences of violence, personality, and political views. At the start of each interview, the respondent’s sociodemographic data were filled out by the respondent together with the survey worker. The respondent was then given a questionnaire to fill out, along with an envelope to put it in and then seal. The interviewer either stayed in the respondent’s home to provide any requested help in filling out the questionnaire, or else left, if this was the respondent’s preference, but remained reachable by telephone. The survey was conducted from March to May 2015.
A total of 2513 persons were included in the study, of whom 2422 were over age 18 and 91 were aged 14 to 18. The participants’ mean age was 48.79 years (standard deviation [SD] = 18.11), and 55.5% were female. Thus, women were overrepresented in the study compared to the overall population, which was 50.94% female as of 31 December 2014 (10). On the other hand, 14- to 18-year-olds were underrepresented in the study, constituting 3.6% of the participants compared to 5% of the overall population on 31 December 2014 (11). Detailed information on the study participants, listed separately for adults and adolescents, are given in Table 2 Among the 14- to 18-year-olds, 5 participants did not answer the questions on sexual violence; among the adults, varying numbers of participants (from 47 to 53) declined to answer individual questions on this topic (Box). The study was conducted in accordance with the Declaration of Helsinki and the ethical guidelines of the International Code of Marketing and Social Research Practice of the International Chamber of Commerce and the European Society for Opinion and Marketing Research. It was approved by the ethics committee of the University of Leipzig.
Table 2. Demographic data of study participants.
| Adults | Adolescents | |
|---|---|---|
| Mean (standard deviation) | ||
| Age, in years | 50.03 (17.26) | 15.91 (1.34) |
| Number (%) | ||
| Sex | ||
| male | 1067 (44.1%) | 52 (57%) |
| female | 1355 (55.9%) | 39 (43%) |
| Living with partner? | ||
| yes | 1374 (57.1%) | 1 (1%) |
| no | 1034 (42.9%) | 88 (99%) |
| Country of citizenship | ||
| Germany | 2338 (96.5%) | 89 (98%) |
| other | 84 (3.5%) | 2 (2%) |
| Religiously affiliated | ||
| yes | 1737 (72.0%) | 72 (80%) |
| no | 675 (28.0%) | 18 (20%) |
| Ever under psychotherapy or psychiatric treatment? | ||
| yes | 430 (17.9%) | 14 (15%) |
| no | 1978 (82.1%) | 77 (85%) |
| Employment | ||
| full-time | 995 (41.1%) | 1 (1%) |
| part-time | 298 (12.3%) | |
| by the hour | 79 (3.3%) | |
| volunteer service / parenthood leave | 12 (0.5%) | 1 (1%) |
| out of work | 136 (5.6%) | |
| retired | 686 (28.3%) | |
| work in the home (housewife/-husband) | 96 (4.0%) | |
| in training | 31 (1.3%) | 9 (10%) |
| in school or university | 89 (3.7%) | 80 (88%) |
| Highest educational attainment (only for adults) | ||
| none | 59 (2.4%) | |
| primary school | 786 (32.5%) | |
| middle school/vocational or technical school | 1062 (43.8%) | |
| high school graduate/university matriculation examination | 286 (11.8%) | |
| university | 229 (9.5%) | |
| Monthly household income (only for adults) | ||
| <1250 € | 421(18.0%) | |
| 1250–2500 € | 1046 (44.8%) | |
| >2500 € | 866 (37.1%) | |
Box. Questions on sexual violence*.
-
Questions for adults (from age 19)
Have you experienced sexual violence by a woman in the last 12 months? (n=2375)
Have you experienced sexual violence by a man in the last 12 months? (n=2374)
Were you forced to have sex against your will by another person in the last 12 months? (n=2369)
In the last 12 months, have you behaved in a sexually aggressive way toward a woman? (n=2370)
In the last 12 months, have you behaved in a sexually aggressive way toward a man? (n=2371)
In the last 12 months, have you forced another person to have sex against their will? (n=2375)
-
Questions for adolescents (14–18 years; n = 86 for all)
Have you experienced sexual violence by a girl of about the same age as you in the last 12 months?
Have you experienced sexual violence by a boy of about the same age as you in the last 12 months?
Were you forced to have sex against your will by another person (girl or boy) in the last 12 months?
In the last 12 months, have you behaved in a sexually aggressive or assaultive way toward a girl of about the same age as you?
In the last 12 months, have you behaved in a sexually aggressive or assaultive way toward a boy of about the same age as you?
In the last 12 months, have you forced another person (girl or boy) to have sex against their will?
*The number in parentheses is the number of participants who answered the question
The documentation of sexual violence
The goal of the survey was to document the frequency in the past 12 months of sexual violence committed either by adults against other adults or by adolescents against other adolescents. To this end, the questions about the respondent’s having experienced sexual violence committed by a man or boy, or by a woman or girl, were deliberately formulated in an open manner. The purpose was to register any sexual encroachments that were subjectively important to the victim. For concretization, these open questions were followed by a question about sexual contact under compulsion. The answers to the three questions were used to generate an overall score about any type of experienced sexual violence. The questions about sexual violence committed by the respondents themselves were analogous to those about sexual violence with the respondents as victims. The individual questions are reproduced in the Box.
The statistical analysis was performed with IBM SPSS Statistics, Version 20.0. Sex differences in prevalence among adults were tested for significance with Fisher’s exact test.
Results
The 12-month prevalences of sexual violence among adults are shown in Table 3. About 1% (n = 22) of the adult participants said they had experienced some type of sexual violence in the preceding 12 months, and about 1.2% (n = 28) said they themselves had manifested sexually aggressive behavior.
Table 3. 12-month prevalences of sexual violence in adults in the present study: number (percent)*1.
| Overall (n=2353–2375) | Men (n=1034–1045) | Women (n=1319–1332) | ||||
|---|---|---|---|---|---|---|
| n (%) | 95% CI | n (%) | 95% CI | n (%) | 95% CI | |
| Have you experienced sexual violence by a woman? | 5 (0.2%) | [0.0; 0.4] | 3 (0.3%) | [0.0; 0.7] | 2 (0.2%) | [0.0; 0.4] |
| Have you experienced sexual violence by a man? | 13 (0.5%) | [0.3; 0.9] | 2 (0.2%)*2 | [0.0; 0.5] | 11 (0.8%)*2 | [0.4; 1.4] |
| Have you been forced to have sex against your will? | 7 (0.3%) | [0.1; 0.5] | 1 (0.1%) | [0.0; 0.3] | 6 (0.5%) | [0.2; 0.8] |
| Have you experienced any kind of sexual violence? | 22 (0.9%) | [0.6; 1.4] | 6 (0.6%) | [0.2; 1.1] | 16 (1.2%) | [0.7; 1.8] |
| Have you been sexually aggressive toward a woman? | 17 (0.7%) | [0.4; 1.1] | 14 (1.3%)*3 | [0.7; 2.1] | 3 (0.2%)*3 | [0.0; 0.5] |
| Have you been sexually aggressive toward a man? | 8 (0.3%) | [0.1; 0.6] | 0 (0.0%)*4 | [0.0; 0.0] | 8 (0.6%)*4 | [0.2; 1.0] |
| Have you forced anyone to have sex against their will? | 11 (0.5%) | [0.2; 0.8] | 7 (0.7%) | [0.2; 1.2] | 4 (0.3%) | [0.1; 0.6] |
| Have you behaved with any kind of sexual aggression? | 28 (1.2%) | [0.8; 1.7] | 15 (1.5%) | [0.8; 2.3] | 13 (1.0%) | [0.5; 1.5] |
*1The total number for individual questions varies because of missing responses
*2p=0.048
*3p=0.002
*4p=0.011 CI, confidence interval; boldface type: significant differences between men and women by Fisher’s exact test
Just under 5 % (n = 4) of the adolescent participants said they had experienced sexual violence at the hands of other adolescents in the preceding 12 months (Table 4). Because of the small number of cases, only absolute frequencies are given.
Table 4. The 12-month prevalence of sexual violence among adolescents (number n).
| Sex | |||
|---|---|---|---|
| Overall (n=86) |
Male (n=49) |
Female (n=37) |
|
| Have you experienced sexual violence by a girl? | 0 | 0 | 0 |
| Have you experienced sexual violence by a boy? | 3 | 1 | 2 |
| Have you been forced to have sex by someone of the same age? | 1 | 0 | 1 |
| Have you experienced any kind of sexual violence by someone of the same age? | 4 | 1 | 3 |
| Have vou been sexually aggressive toward a girl? | 2 | 2 | 0 |
| Have you been sexually aggressive toward a boy? | 0 | 0 | 0 |
| Have you forced a boy or girl to have sex against their will? | 0 | 0 | 0 |
| Have you been sexually aggressive in any way? | 2 | 2 | 0 |
Discussion
This is the first study in Germany in which the prevalence not only of personally experienced sexual violence, but also of the sexually aggressive behavior of the respondents themselves, was estimated in a population-based, representative sample. Specific questions were asked not just about sexual violence in the narrowly defined sense (being forced to have sex against one’s will), but also about subjectively experienced sexual violence. The 12-month prevalences of having experienced sexual violence in the narrow sense (0.1% for men, 0.5% for women) are comparable to figures from the USA: in a representative American sample, the 12-month prevalence of rape or attempted rape was found to be 0.1% for men and 0.3% for women (12). A different representative survey of women yielded a 0.9% estimated annual prevalence of being raped (13). A comparison of our findings with the figures on sexual offenses contained in the German official crime statistics, which naturally include only incidents that became known to the authorities (Table 1), reveals that the official statistics markedly underestimate the phenomenon: the prevalence of experienced sexual violence, as reflected by the official statistics, is 30 or 90 times lower than that revealed by our study (depending on whether the narrow or the broad definition is used). The difference among men is particularly marked , with our study indicating a prevalence 100 or 600 times higher than the official statistics would indicate, yet the difference among women—25 or 60 times higher—is quite pronounced as well. The present findings are hard to compare with those of Hellmann’s representative survey (5) because of the different periods of observation. If one assumes, when 5-year prevalence figures are reported, that the events in question were evenly distributed over this period, then Hellmann’s findings are comparable to ours for sexual violence in the narrow sense.
The findings of previous studies (2, 12, 14) imply that only 5–25% of women who are raped make a complaint to the police, with their relationship to the perpetrator and the circumstances surrounding the event markedly influencing the likelihood of a complaint. Sexual violence by a husband or partner (4), or in the setting of alcohol or drug use (15), results much less often in a complaint. In our sample, the frequency of women making a complaint to the police after being raped (sexual violence in the narrow sense) was about 4%, in accordance with previous findings. On the other hand, male victims of sexual violence in the narrow sense make a complaint in only 1% of cases. Factors such as shame may play an even larger role among male victims than among female victims. In particular, if a man is a victim of sexual violence perpetrated by a woman, the event may collide with the victim’s own idea of masculinity and thus be denied; this, of course, would further lessen the victim’s readiness to make a complaint (16).
A further reason for the major discrepancy between the prevalence of sexual violence (broadly defined) reflected by our findings and that reflected by the official crime statistics may be that our questions elicited reports of cases of sexual violence that the victims themselves thought were not crimes and thus did not report to the police. Many cases may have involved sexual violence by partners; such cases are very common, yet much less often reported to the police than sexual violence by non-partners (12). This is most unfortunate, because sexual violence that subjectively seems not to be criminal and sexual violence committed by partners can, indeed, cause major health problems (2, 3, 4). Unwillingness to make a complaint can also make it difficult or impossible to put an end to a living situation that is plagued by sexual violence, particularly when the victim’s partner is the perpetrator.
This was also the first survey in Germany carried out on a population-based, representative sample that documented the sexually aggressive behavior of the respondents themselves. Here, too, the prevalence figures were much higher than those in the official crime statistics, by a factor of 55 (narrow definition) or 133 (any event). The official statistics especially underestimate sexual violence committed by women. We suspect the reasons for this are similar to those discussed above. Shame and denial play a role among male victims of sexual violence committed by women; moreover, the concept of sexual violence committed by women remains largely taboo among the general public, despite increasing recognition by researchers (17).
Limitations
The differences between men and women revealed by this study with respect to the prevalence of having suffered sexual violence and of having perpetrated it must be interpreted with caution, in view of the low case numbers. The study provides evidence that men are more often victims of sexual violence by women than by men, and that women more often display sexually aggressive behavior toward men than other men do. A limitation of the study is that sexual orientation was not asked about; the findings thus cannot reveal whatever influence sexual orientation may have had on the events in question.
Low case numbers also make it difficult to compare the prevalence of sexual violence by adolescents against adolescents, as revealed by this study, with the findings of earlier studies, even if the figures are numerically similar (7). In our opinion, further studies are needed to determine the true prevalence of sexual violence committed against children and adolescents by adults and by comparably-aged persons.
The general limitations of the study are related to the imperfect representativeness of the sample, as indicated both by the sex distribution and by the low percentage of adolescents, even though the data analysis was carried out separately for these groups. As in all studies on sexual violence that rely on self-reported data, there is the risk of a tendency among respondents to provide socially acceptable answers; as a result, in particular, questions about one’s own sexually aggressive behavior may go unanswered or be answered falsely. Likewise, questions relating to one’s own experience as a victim may be answered falsely or not at all out of a desire to spare oneself emotional stress and to avoid confronting the subject. The presence of a survey worker while the informant is filling out the questionnaire may intensify this effect. The short period of observation (one year) and the consequently low numbers of events make the responses of men and women difficult to compare.
On the other hand, the short period of observation provides an advantage as well. Persons probably remember events involving sexual violence that happened in the past year more clearly than those that may have happened at any time in their lifetimes (which subjects were asked about in other studies). This is particularly true if the event was not associated with any lasting emotional stress. Moreover, the random-route procedure for finding family households systematically excludes persons living in institutions. Sexual violence among such persons (including institutionalized adolescents) is more common than in the general population (18). Thus, the prevalences found in this study are more likely underestimates than overestimates.
Overview
The findings in this representative sample are the first ones that simultaneously relate to the study subjects’ experience of having suffered from sexually aggressive behavior and of having committed it. (This study does not address the sexual abuse of children.) The findings suggest, in particular, that the prevalences of male victims of sexual violence on the one hand, and of female perpetrators on the other, have been underestimated until now. It remains clear, however, as shown in earlier studies, that women are more often victims than men, while men are more often perpetrators than women. Physicians and psychotherapists need to be sensitive to this subject, as victims of sexual violence make greater-than-average use of health-care resources. An appropriate response on the part of these professionals to patients’ experiences of sexual violence, including readiness to give them an opportunity to talk about what they have gone through, can markedly improve outcomes with respect to post-traumatic emotional disturbances (19).
The high prevalence of subjectively experienced sexual violence in everyday life calls for further research to determine the conditions in which such violence arises, with special attention to hitherto neglected constellations of victims and perpetrators, e.g., sexual violence by women or against men.
Key Messages.
In 2015, 2513 persons in a population-based representative sample were asked questions about sexual violence.
0.6% of adult men and 1.2% of adult women reported having experienced sexual violence in the last 12 months.
1.5% of adult men and 1.0% of adult women reported having behaved in a sexually aggressive way themselves in the last 12 months.
The present survey yielded higher percentages of women as perpetrators and of men as victims of sexual violence than the official crime statistics.
Increased sensitivity for the prevalence of experienced sexual violence can help the affected persons obtain the help they need.
Acknowledgments
Translated from the original German by Ethan Taub, M.D.
Footnotes
Conflict of interest statement
Dr. Allroggen has received lecture honoraria from Profecta AG.
Prof. Fegert has received payment for editing, writing, and co-authoring publications related to the topic of this article from various book and journal publishing houses, particularly Springer and Beltz Juventa.
The remaining authors state that they have no conflict of interest.
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