Dr. Mary V. Seeman, MD
Background: Vulnerable populations are sometimes targets for violence and sexual exploitation; this has been
reported with respect to women with serious mental illnesses such as schizophrenia. Aim: The aim of this
review is to summarize the recent literature on this topic and to outline promising strategies for prevention.
Method: Relevant search terms were used in the Google Scholar database from 2000 to the present, and 50
English language papers were selected for review. Results: Women with schizophrenia are targets for sexual
harassment and violence, not only domestically, but also on the street, and in institutions. Perpetrators can
be intimate partners, strangers, and hospital or prison staff. Women with schizophrenia are sometimes sex
trafficked. They are vulnerable because of isolation, passivity, cognitive defects, psychotic symptoms, substance
abuse, homelessness, and poverty, and, as a consequence of exploitation, they suffer shame and guilt, increased
severity of psychotic symptoms, and increased risk of sexually transmitted disease, unwanted pregnancy, and
abortion. On psychiatric assessment, they are seldom asked about the practice of survival sex or about sexual
exploitation, and seldom disclose these aspects of their life. Clinical programs are beginning to become available
that address self-stigma, educate about risk factors for sexual exploitation and teach safety and self-defense as
well as conflict resolution. Psychiatric services are instituting screening procedures for employees, appropriate
staff education, and improvements in surveillance measures and policies. Conclusion: Because of increasing
awareness of harassment and exploitation of women in general, there is mounting concern about women made
more vulnerable than others as a result of severe mental illness.
