









































5

Graduate Student Journal of Psychology
Fall 2024 - Vol. 23

Copyright 2024 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University

Sexual and Intimate Partner Violence Against Women 
with Schizophrenia: A Scoping Review

	 Intimate	partner	violence	(IPV)	is	defined	as	any	
conduct occurring within an intimate relationship that 
inflicts	physical,	sexual,	or	psychological	harm.	IPV	has	
sparked	significant	public	health	apprehension	due	to	
the growing prevalence highlighted by diverse global 
news	outlets.	It	has	infiltrated	all	societal	levels,	emerg-
ing as the predominant manifestation of gender-based 
violence, leading to immediate and enduring health re-
percussions	for	those	affected.	Population-based	prev-
alence estimates typically fail to accurately represent 
the problem’s magnitude due to substantial underre-
porting;	 nonetheless,	 IPV	 still	 significantly	 contrib-
utes to crime statistics in all societies (Afe et al., 2016). 
Indeed, as many as 38% of all murders of women are 
committed by intimate partners (World Health Or-
ganisation	[WHO],	2021).	Research	findings,	as	high-
lighted by Afe et al. (2017), indicate that women, who 
are	disproportionately	 impacted	by	sexual	violence—
covering	 non-consensual	 sexual	 activities,	 coercion,	
exploitation,	harassment,	 or	 advances,	 irrespective	of	
the perpetrator's relationship with the victim or the 
setting—	and	IPV	are	at	heightened	risk	if	they	experi-
ence	severe	mental	illness	(SMI).	SMI	is	defined	as	in-
dividuals with persistent or recurrent mental disorders 
significantly	affecting	their	functioning,	compared	to	
the	 general	population.	This	negatively	 affects	wom-
en’s	physical,	mental,	sexual,	and	reproductive	health	
(WHO, 2021). Thus, minimal research has been con-
ducted	 on	 the	 sexual	 and	 IPV	 victimization	 experi-

enced	by	women	with	schizophrenia,	a	severe	mental	
illness	 characterized	 by	 hallucinations,	 delusions,	 so-
cial withdrawal, diminished pleasure and motivation, 
cognitive	 deficits,	 and	 other	 symptoms	 (Darves-Bor-
noz	 et	 al.,	 1995).	 As	 such,	 the	 objective	 of	 this	 re-
search is to elucidate our knowledge on this topic.
While IPV encompasses verbal, psychological, physi-
cal,	and	sexual	abuse,	we	have	opted	to	draw	a	distinc-
tion	between	IPV	and	sexual	violence.	Specifically,	our	
discussion	 of	 IPV	 encompasses	 sexual	 violence	 per-
petrated by intimate partners, whereas the section on 
sexual	 violence	 includes	 acts	 perpetrated	by	 intimate	
partners as well as by individuals other than partners. 
Intimate Partner Violence Against Women
	 Globally,	 641	 million	 women	 are	 affected	 by	
partner violence, establishing it as the most prevalent 
form	of	 violence	 affecting	women	 (Buchholz,	 2021).	
During their lives, one out of three women worldwide 
will	experience	IPV	(Buchholz,	2021).	Adding	to	this	
distressing statistic, globally, women constitute 20 per-
cent	of	all	murder	victims,	and	the	majority	of	these	cas-
es	involve	killings	by	a	partner	or	ex-partner	(Buchholz,	
2021).	Characterized	by	any	behaviour	within	an	inti-
mate	relationship	causing	physical,	sexual,	or	psycho-
logical harm, IPV can account for physical aggression, 
sexual	manipulation,	psychological	maltreatment,	and	
controlling conduct done by a present or past partner 
(Afe et al., 2016). The rising media coverage of this be-
haviour has raised substantial public health concerns 

Kellie-Anne	Bélisle,	Adriana	Mendrek,	Sarah	Hepworth	&	Joel	Montanez
Psychology Department, Bishop’s University, Sherbrooke, Canada

Background: Globally, 641 million women are touched by intimate partner violence (IPV), establishing it as the 
most	prevalent	form	of	violence	affecting	women.	Women,	who	are	already	disproportionately	affected	by	sexual	
and IPV, face an elevated risk when dealing with severe mental illnesses (SMI) compared to the general population. 
Schizophrenia,	classified	as	an	SMI,	poses	numerous	obstacles	that	impact	women’s	ability	to	maintain	employment,	
good	health,	and	sustain	stable	relationships.	Nevertheless,	limited	data	exists	on	IPV	against	women	with	schizo-
phrenia	and	its	effect.	Aims:	The	objective	of	this	scoping	review	was	to	summarize	the	available	literature	on	sexual	
and	IPV	against	women	with	schizophrenia	and	underlie	future	avenues	of	research.	Methods: We conducted an 
electronic search using keywords in the following databases: APA PsychInfo, PubMed, Scopus, Google Scholar, and 
Psychology	and	Behavioral	Sciences	Collection.	The	search	yielded	a	total	of	6,099	articles.	Upon	title	and	abstract	
review,	97	articles	were	retained	for	full-text	reading,	after	which	7	articles	were	included	in	this	review.	Results: The 
available	articles	reveal	an	association	between	sexual	violence	and	IPV	against	women	with	schizophrenia.	Young-
er	women	diagnosed	with	schizophrenia,	especially	those	with	low	income	or	unemployed,	are	at	a	higher	risk	of	
experiencing	sexual	and	IPV.	This	victimization	 increases	 the	 likelihood	of	suicide	and	exacerbates	psychopathol-
ogy. Conclusion:	Research	should	examine	care-setting	 interventions	for	women	with	schizophrenia,	who	are	at	
increased	risk	of	sexual	and	IPV,	aiming	to	prevent	severe	harm.	Implementation	of	preventive	measures	is	essential	
for enhancing healthcare and societal transformation.
 Keywords: IPV,	sexual	violence,	schizophrenia,	women,	victimization



6

BÉLISLE	ET.	AL

globally.	 Beyond	 the	 immediate	 potential	 traumatic	
events, it is imperative to acknowledge the enduring 
short and long-term consequences faced by survivors. 
This underscores the urgent need for multifaceted 
approaches to prevention and intervention, address-
ing the root causes of IPV while providing compre-
hensive support for survivors to rebuild their lives.
Sexual Violence Against Women
	 According	 to	 the	 World	 Health	 Organization’s	
Multi-Country Study (MCS), the lifetime prevalence 
of	women	experiencing	sexual	abuse	by	a	partner	was	
between	6%	and	59%	(WHO,	2002).	Sexual	violence	
is a profound human rights violation that encom-
passes	 any	 sexual	 activity	 involving	 coercion,	 sexual	
exploitation,	 harassment,	 or	 advances	 committed	 by	
an individual, irrespective of the relationship with 
the	victim,	and	the	environment	(Dartnall	&	Jewkes,	
2013; Krug et al., 2022). As perpetrators are generally 
men known by the victims and commonly intimate 
partners,	 it	 is	 important	 to	 acknowledge	 that	 sexual	
violence is pervasive in every society and frequent-
ly	 targets	 women	 (Dartnall	 &	 Jewkes,	 2013;	WHO,	
2002). Notably, women facing mental health challeng-
es	experience	a	higher	victimization	rate,	reaching	53	
incidents per 1000 individuals, in contrast to the gen-
eral population's rate of 17 incidents per 1000 people 
(Van	Deinse	et	al.,	2019).	Indeed,	violent	victimization	
against	women	with	SMI	was	estimated	at	25%	greater	
than	the	general	population	(Van	Deinse	et	al.,	2019).	
Therefore, it is crucial to acquire deeper insights into 
the	topic,	given	that	sexual	violence	can	lead	to	lasting	
adverse	 effects,	worsen	mental	health	challenges,	 and	
contribute to the emergence of concurrent disorders.
Schizophrenia
	 As	 of	 2019,	 approximately	 0.3	 percent	 of	 the	
world	population	was	reported	to	have	schizophrenia	
(OWID,	2019).	This	disorder	can	disturb	various	fac-
ets of an individual’s mental faculties such as thoughts, 
perception, speech, emotions, behaviour, and social 
functioning	(Schultz	et	al.,	2007).	Symptoms	may	en-
compass hallucinations (e.g., hearing voices), delusions 
(e.g., paranoia), social withdrawal, lack of pleasure, 
loss	of	motivation,	cognitive	deficits,	and	other	prob-
lems	 disrupting	 patients’	 lives	 (Schultz	 et	 al.,	 2007).		
	 As	schizophrenia	affects	various	facets	of	women’s	
lives,	many	have	difficulty	relating	and	connecting	to	
the world around them, making these women vulner-
able to feelings of loneliness and isolation. Moreover, 

the	entourage	of	women	with	schizophrenia	may	have	
difficulty	understanding	that	their	illness	may	compli-
cate their relationships. This challenge becomes espe-
cially daunting when attempting to establish intimate 
relationships, as these women are more vulnerable to 
emotional	and	physical	victimization.	Indeed,	in	Cher-
nomas’s	 (2000)	research,	women	expressed	how	they	
feared intimacy as many felt preyed upon once their 
psychiatric history was known. Additionally, numer-
ous	 women	 shared	 experiences	 of	 childhood	 abuse,	
rape, and physical mistreatment, leading to a strong re-
luctance	and	fear	towards	engaging	in	sexual	intimacy	
(Chernomas et al., 2000). These acute stressors have 
been	 identified	as	 factors	contributing	 to	an	elevated	
risk of suicidal behaviours (Chernomas et al., 2000). 
As	 the	 lifetime	 prevalence	 of	 suicide	 in	 the	 schizo-
phrenia population has been estimated to be ten times 
higher than in the general population, the severity of 
symptoms	 and	 victimization	 leads	 to	 a	 greater	 num-
ber	 of	 suicide	 attempts	 in	 women	 with	 schizophre-
nia	 (Carlborg	 et	 al.,	 2010;	Thara	&	Kamath,	 2015).
 In terms of employment, certain women opt to be 
homemakers, remain on disability pensions, or engage 
in	work	fields	 (Chernomas	et	 al.,	2000).	While	 some	
express	a	desire	to	work,	they	are	apprehensive	about	
their ability to cope with the stress of employment. 
They	fear	 the	potential	of	 falling	 ill	 and	being	finan-
cially	 strained,	coupled	with	 the	challenge	of	finding	
alternative employment (Chernomas et al., 2000). 
Moreover,	many	women	diagnosed	with	 schizophre-
nia have encountered limiting messages regarding 
their ability to pursue employment or education due 
to their disability, underscoring their apprehension 
about entering the workforce (Chernomas et al., 2000). 
	 Schizophrenia	has	devastating	effects	not	only	on	
women’s emotional and cognitive health but also on 
their physical health. The negative impacts of antipsy-
chotic medications include weight gain, amenorrhea, 
reduced libido, lactation, and facial hair growth (Cher-
nomas	et	al.,	2000).	These	side	effects	have	a	detrimen-
tal impact on women’s well-being and undermine 
their sense of self and femininity. Furthermore, wom-
en	with	 schizophrenia	 have	 expressed	 a	 lack	 of	 suffi-
cient information from health professionals regarding 
family planning, pregnancy, parenting, or menopause, 
particularly in light of their mental health condition 
and its psychopharmacologic treatment (Chernomas 
et al., 2000). The lack of communication and sup-



7

VIOLENCE	AGAINST	WOMEN	WITH	SCHIZOPHRENIA

port from healthcare professionals can lead women 
to be hesitant to discuss menstrual irregularities and 
sexuality	 as	 they	 face	 insufficient	 responses	 to	 their	
concerns on these matters (Chernomas et al., 2000).
	 Women	 with	 schizophrenia	 constitute	 a	 vul-
nerable population as their illness impacts multiple 
aspects of their lives, including their potential for 
employment, pursuit of higher education, health, 
and ability to establish and maintain stable relation-
ships.	 Given	 that	 symptoms	 may	 exacerbate	 in	 the	
face	 of	 challenges,	 women	 with	 schizophrenia	 also	
exhibit	 a	 higher	 likelihood	 of	 suicide	 compared	 to	
the general population, highlighting the pressing 
need to improve our comprehension of women’s cir-
cumstances	 and	 their	 vulnerability	 to	 victimization.
IPV, Sexual Violence and Schizophrenia
 As IPV against women is highly prevalent, past lit-
erature has indicated that women with SMI are at ele-
vated	risk	of	being	victims	of	sexual	and	IPV	(Afe	et	al.,	
2017).	Across	various	research,	the	lifetime	exposure	to	
sexual	and	physical	abuse	fell	between	43%	and	81%	for	
women with SMI (Kim et al., 2006). These women are 
more susceptible to abusive and violent relationships 
due to the persistent, debilitating impact of the illness 
and	social	stigmatization.	Particularly,	it	was	found	by	
Thara	&	Kamath	(2015),	that	women	with	schizophre-
nia were severely disabled compared to women with 
other diagnoses. This highlights the need to intensify 
focus	 on	 schizophrenia,	 particularly	 considering	 the	
insufficient	available	data	regarding	the	prevalence	of	
sexual	and	IPV	against	women	diagnosed	with	schizo-
phrenia and its potential impact on their condition.
 Following the methodological framework pro-
posed	 by	Arksey	 and	O’Malley	 (2005)	 and	 Levac	 et	
al. (2010), this scoping review seeks to describe the 
present	 literature	 regarding	 IPV	 and	 sexual	 violence	
among	 women	 with	 schizophrenia	 worldwide.	 Giv-
en the pervasive nature of violence against women 
worldwide, causing harm to millions, and being es-
pecially prevalent among women with SMI, it is im-
perative to thoroughly investigate this phenomenon. 
The impact of such violence on symptoms, treatment 
complexities,	 and	 the	 overall	 quality	 of	 life	 for	 these	
women cannot be understated. Mental health pro-
fessionals must be aware and diligent surrounding 
this issue by carefully assessing for this factor (Afe et 
al.,	 2016).	By	 gaining	 a	deeper	understanding	of	 the	
relationship	between	sexual	violence,	 IPV,	and	wom-

en	 with	 schizophrenia,	 more	 effective	 strategies	 for	
prevention, intervention, and support can be devel-
oped.	 Ultimately,	 this	 examination	 can	 contribute	
to	an	enhanced	comprehension	of	 the	 issue,	offering	
insights into potential avenues for future research.

Methodology
 As a scoping review, this article is based on the 
methodological framework developed by Arksey and 
O’Malley	 (2005)	 and	 refined	 by	 Levac	 et	 al.	 (2010)	
following PRISMA (Preferred Reporting Items for 
Systematic Reviews and Meta-Analyses) guidelines 
(Tricco et al., 2018). The purpose of scoping reviews 
is to provide a comprehensive overview of a new area 
of research and identify potential gaps that need to 
be	 addressed.	According	 to	 recent	 literature,	five	key	
steps are necessary for conducting scoping reviews: 
1) identifying the research question; 2) identifying 
relevant studies; 3) selecting studies; 4) charting the 
data;	and	5)	collating,	summarizing,	and	reporting	re-
sults	(Arksey	and	O’Malley,	2005;	Levac	et	al.,	2010).
The main question directing this review is “What is 
the	state	of	knowledge	regarding	sexual	and	 intimate	
partner	violence	against	women	with	schizophrenia?”
Literature Research 
 An electronic literature search was initiated on 
September 6, 2023, through the following databases: 
APA PsychInfo, PubMed, Scopus, Google Scholar, 
and	 Psychology	 and	 Behavioral	 Sciences	 Collection.	
In	collaboration	with	an	academic	librarian,	KAB	de-
veloped a search strategy using controlled vocabulary 
(MeSH	 and	 index	 terms)	 and	 keywords	 relevant	 to	
“sexual	 violence,”	 “intimate	 partner	 violence	 (IPV)”	
and	 “schizophrenia.”	 Continual	 collaboration,	 val-
idation, and discussion followed with SH and AM.
	 For	 sexual	 violence	 and	 intimate	 partner	 vio-
lence,	 the	 terms	 employed	 for	 the	 search	were:	 “sex-
ual	 violence”	 OR	 “intimate	 partner	 violence”	 OR	
“intimate	 partner	 abuse”	 OR	 “sexual	 viol*”	 OR	
“sexual	 abuse”	 OR	 “sexual	 assault”	 OR	 “sexual	 co-
ercion”	 OR	 “sexual	 harassment”	 OR	 “sex	 offenses”	
OR	 “acquaintance	 rape”	 OR	 “domestic	 violence”	
OR	 “victimization”	 OR	 “marital	 rape.”	 For	 schizo-
phrenia,	 the	 terms	 employed	 were:	 “schizophre-
nia.”	 The	 search	 strategy	 is	 presented	 in	 Figure	 1.
Study Selection 
  After conducting the database search, all iden-
tified	 literature	 was	 imported	 into	 Zotero	 reference	



8

BÉLISLE	ET.	AL

management software (v6). The search generated 
6,099	articles,	of	which	4,459	remained	after	 remov-
ing	 duplicates.	 To	 determine	 eligibility	 for	 full-text	
review,	KAB	and	SH	screened	titles	and	abstracts.	To	
be selected, studies had to meet the following inclu-
sion criteria: (1) the primary theme had to be related 
to	 both	 sexual	 violence,	 IPV,	 and	 schizophrenia	 (2)	
articles	were	published	in	a	peer-reviewed	journal,	(3)	
articles	were	available	in	English	or	French,	(4)	articles	
could	not	be	systematic	reviews,	(5)	article	population	
had to be women (included studies that distinguished 
findings	between	sexes),	(6)	excluded	children	and	(7)	
article	population	was	diagnosed	with	schizophrenia.	
The	authors	chose	to	exclude	children	from	the	study	
due	 to	 childhood-onset	 schizophrenia	 being	 recog-
nized	as	a	distinct	subtype	of	the	disorder,	necessitat-
ing separate research. Incorporating studies involving 
children	would	primarily	delve	into	child	sexual	abuse,	
which warrants dedicated investigation on its own.
	 	A	 total	 of	 97	 articles	were	 retained	 for	 full-text	
review,	 and	 the	 final	 selection	 was	 agreed	 upon	 by	
SH	 and	 AM.	 Following	 the	 full-text	 review,	 sev-
en articles were retained and included in the re-
view. For each included article, references, authors, 
and	 “cited	 by”	 were	 scanned	 to	 identify	 additional	
relevant	 studies.	 The	 flowchart	 of	 the	 study	 selec-
tion and screening process can be seen in Figure 2.
Data extraction and analysis 
 A charting form was used to facilitate team dis-
cussion	 and	 approval	 during	 full-text	 screening	 and	
descriptive analysis. Using charting forms developed 
by	Peters	et	al.	(2020),	Lauzon-Schnittka	et	al.	(2022),	
and	Arnstein	et	al.	(2020),	we	extracted	the	following	
information	for	each	article:	authors,	 journal,	year	of	
publication, study location, the number of partici-
pants, age of participants, the aim of the study, meth-
odology,	 and	 important	 results.	 The	 extraction	 was	
done	by	KAB	and	validated	by	SH	and	AM.	The	results	
were	 then	 summarized,	 and	 narrative	 synthesis	 was	
employed	to	 report	 the	findings	 (Popay	et	al.,	2006).

Results
 The characteristics of the 7 retained articles are 
displayed in Table 1.
Study characteristics 
 Among the selected articles, one was published 
in	1995	(Darves-Bornoz	et	al.,	1995)	and	one	in	2006	
(Kim	et	al.,	2006).	A	total	of	5	articles	were	published	

after	2013	(Afe	et	al.,	2016,	2017;	Khalifeh	et	al.,	2015;	
Leslie	et	al.,	2023;	Yildirim	et	al.,	2014).	Two	studies	
were conducted in Nigeria (Afe et al., 2016, 2017), 
one	 in	 Turkey	 (Yildirim	 et	 al.,	 2014),	 one	 in	 South	
Korea	 (Kim	 et	 al.,	 2006)	 and	 one	 in	Canada	 (Leslie	
et	al.,	2023).	Two	studies	were	 from	Europe,	 includ-
ing	one	from	France	(Darves-Bornoz	et	al.,	1995)	and	
the	 other	 from	England	 (Khalifeh	 et	 al.,	 2015).	The	
number of participants in the selected studies ranged 
from	70	 to	1,802,645.	Two	 articles	 examined	 female	
outpatients	diagnosed	with	schizophrenia	with	an	av-
erage age of 38.3 years (Afe et al., 2016, 2017), while 
Kim	et	al.	(2006)	had	an	average	age	of	33.5	years.	Two	
studies consisted of in-patients undergoing treatment 
(Khalifeh	et	al.,	2015;	Yildirim	et	al.,	2014).	Yildirim	
et al. (2014) sample consisted of female patients with 
an	 average	 age	 of	 39.24	 years.	 Khalifeh	 et	 al.	 (2015)	
randomly	 recruited	 patients	 with	 SMI	 (59.7%	 with	
schizophrenia)	through	community	mental	health	ser-
vices, with an average age of 40.8 years. Two studies 
had	 a	 sample	of	 in	 and	outpatients	with	 schizophre-
nia	 (Darves-Bornoz	 et	 al.,	 1995;	 Kim	 et	 al.,	 2006).	
Kim et al. (2006) had a sample with an average age 
of	 33.5	 years	 while	 Darves-Bornoz	 and	 colleagues	
(1995),	 recruited	females	with	an	average	age	of	34.3	
years.	Lastly,	Leslie	et	al.	(2023)	study	compared	wom-
en	 in	 Ontario	 with	 or	 without	 schizophrenia	 and	
who became pregnant between April 1, 2004, and 
March 31, 2018, with an average age of 30.6 years. 
Methodology 
 The seven articles were quantitative (Afe et al., 
2016,	 2017;	 Darves-Bornoz	 et	 al.,	 1995;	 Khalifeh	 et	
al.,	 2015;	Kim	 et	 al.,	 2006;	 Leslie	 et	 al.,	 2023;	 Yildi-
rim et al., 2014). One article was surveyed through a 
computer-assisted face-to-face interview while also 
incorporating a self-completion module (Khalifeh 
et	 al.,	 2015).	One	 article	 utilized	 a	 population-based	
cohort study involving the registry of administrative 
health and clinical data from 2004 to 2018 in On-
tario,	 Canada	 (Leslie	 et	 al.,	 2023).	 Two	 studies	 em-
ployed	 semi-structured	 interviews	 (Darves-Bornoz	 et	
al.,	 1995;	Kim	et	 al.,	 2006).	Finally,	Afe	 et	 al.	 (2016,	
2017) studies employed interviews to survey wom-
en.	 Even	 though	 these	 studies	 share	 the	 same	 sam-
ple, they vary in terms of the assessment measures 
employed and the number of participants recruited. 



9

VIOLENCE	AGAINST	WOMEN	WITH	SCHIZOPHRENIA

Prevalence of Intimate Partner Violence Among 
Women with Schizophrenia
	 In	 four	 articles,	 the	 authors	 aimed	 to	 explore	
IPV	 among	 women	 with	 schizophrenia	 (Afe	 et	 al.,	
2016,	2017;	Khalifeh	et	al.,	2015;	Leslie	et	al.,	2023).	
The four studies reported a higher prevalence of 
IPV	among	women	with	schizophrenia	 than	women	
without this diagnosis. Afe et al.'s (2016) aim was to 
study the various patterns of IPV against women with 
schizophrenia	and	its	association	with	psychopatholo-
gy.	The	results	indicated	that	75%	of	the	participants	
experienced	at	least	one	occurrence	of	IPV	(Afe	et	al.,	
2016). Afe et al. (2017) investigated socio-demograph-
ic and other attributes of partners of women with 
schizophrenia	 in	Nigeria.	They	 reported	 that	73%	of	
the	participants	 experienced	 IPV	at	 least	once	which	
is much higher than the prevalence of non-mentally 
ill women found at 40% in Nigeria (Afe et al., 2017). 
	 Khalifeh	 et	 al.	 (2015)	 assess	 and	 compare	 the	
prevalence	 and	 consequences	 of	 domestic	 and	 sexu-
al	violence	among	 individuals	with	SMI,	with	59.7%	
of	 the	 participants	 diagnosed	 with	 schizophrenia,	
and the general population. Their research found 
that women with SMI reported higher domestic vi-
olence	 (69%)	 compared	 to	 the	 control	 group	 (33%)	
(Khalifeh	et	al.,	2015).	The	SMI	population	also	had	
a	 higher	 rate	 of	 sexual	 violence	 (10%)	 compared	 to	
the	 control	 group	 (2%)	 (Khalifeh	 et	 al.,	 2015).	 Last-
ly,	 Leslie	 et	 al.	 (2023),	 aimed	 to	 assess	 and	 compare	
the risk of interpersonal violence necessitating an 
emergency	 department	 (ED)	 visit	 during	 pregnan-
cy or within one year postpartum among women 
with	and	without	schizophrenia.	They	found	a	high-
er	 risk	of	ED	visits	 for	 interpersonal	violence	 among	
women	with	 schizophrenia	 (4%)	 compared	 to	wom-
en	without	schizophrenia	(0.4%)	(Leslie	et	al.,	2023).	
Prevalence of sexual violence among women with 
schizophrenia 
	 In	 three	 studies,	 the	 authors	 examined	 sexual	 vi-
olence	committed	against	women	with	schizophrenia	
(Darves-Bornoz	et	al.,	1995;	Kim	et	al.,	2006;	Yildirim	
et al., 2014). All three studies indicated that women 
with	 schizophrenia	 have	 a	 high	 prevalence	 of	 sexual	
abuse. In Kim et al.'s (2006) article, the aim was to 
present	findings	on	the	prevalence	of	sexual	abuse	 in	
female	patients	attending	a	mental	hospital	for	schizo-
phrenia in South Korea. They found that 37% of the 
study’s	population	had	a	history	of	sexual	abuse	where	

29.7%	were	abused	by	a	family	member,	32.4%	by	an	
unrelated perpetrator and 60% by a stranger (Kim et 
al.,	2006).	In	Darves-Bornoz	et	al.	(1995),	the	aim	was	
to	 study	women	with	 schizophrenia	 and	bipolar	dis-
order	in	relation	to	sexual	victimization.	It	was	discov-
ered that the prevalence of rape was found to be 23% 
among	women	with	schizophrenia,	in	contrast	to	the	
general	population	rate	of	7%	or	8%	(Darves-Bornoz	et	
al.,	1995).	In	this	research,	 the	perpetrators	of	sexual	
violence	were	 family	members	 (Darves-Bornoz	 et	 al.,	
1995).	Lastly,	Yildirim	et	al.	(2014),	aimed	to	explore	
the	effect	of	adulthood	trauma	such	as	sexual	harass-
ment	 and	 sexual	 abuse	 experienced	 by	 patients	with	
schizophrenia	who	did	not	have	a	history	of	child	abuse.	
They	 found	 that	 24.3%	 of	 patients	 had	 experienced	
sexual	 abuse	 during	 their	 adulthood	 whereas	 14.3%	
were abused by a stranger and 10% by someone they 
knew	 (Yildirim	 et	 al.,	 2014).	 For	 sexual	 harassment,	
28.6%	were	 sexually	 harassed	 (Yildirim	 et	 al.,	 2014).	
	 These	 three	 studies	 focused	on	 sexual	 abuse	not	
committed within an intimate relationship. Nonethe-
less, three articles which focused on IPV also assessed 
sexual	 assaults	 committed	 towards	 schizophrenic	
women.	Khalifeh	 et	 al.	 (2015),	 found	 in	 their	popu-
lation	 that	 61%	 of	 women	 experience	 sexual	 assault	
compared	 to	 21%	 of	women	without	 schizophrenia.	
In both Afe et al.'s (2016, 2017) studies, the authors 
reported	that	24%	of	the	sample	was	sexually	assaulted.	
IPV & Sexual Violence Association with Symp-
tomology 
 Out of the seven articles, four found an associa-
tion	between	IPV,	sexual	violence	and	higher	psycho-
pathology	(Afe	et	al.,	2016,	Darves-Bornoz	et	al.,	1995;	
Kim	et	al.,	2006;	Yildirim	et	al.,	2014),	while	Afe	et	al.	
(2017) revealed that patients who do not adhere to 
treatment	and	experience	symptom	improvement	are	
more likely to become victims of IPV. Afe et al. (2016) 
found	 that	 participants	who	 reported	 sexual,	 verbal,	
and physical IPV indicated higher psychopathology 
(e.g., worsened psychiatric symptoms). Higher psy-
chopathology was also associated with a decrease in 
physical	health,	such	as	“injuries,	gynecological	prob-
lems, depression of immunity and possibly untimely 
death”	(Afe	et	al.,	2016,	p.	8).	Kim	et	al.	(2006),	identi-
fied	higher	psychopathology	scores	within	the	abused	
population	 indicating	 increased	 distress	 in	 somatiza-
tion, obsessive-compulsive behaviours, depression, 
and	anxiety,	while	 also	 indicating	greater	dissociative	



10

BÉLISLE	ET.	AL

expression.	Yildirim	et	al.	(2014),	reported	higher	psy-
chopathology	 such	 as	 anxiety,	 aggression,	 hallucina-
tions,	 and	 delayed	 gratification	 among	 patients	 who	
experienced	sexual	abuse.	Darves-Bornoz	et	al.	(1995)	
also stated a relationship between the occurrence of 
rape	and	the	increased	chronicity	of	the	disorder.	Last-
ly, regarding treatment adherence, Afe et al. (2017) 
noted	 a	 counterintuitive	 finding	 suggesting	 that	 ir-
regular medication use increases the odds of IPV and 
individuals with a shorter duration of illness are more 
likely	 to	 experience	 sexual,	 physical	 and	 verbal	 IPV.	
Suicide 
	 Among	the	seven	articles,	five	studies	discussed	the	
risk	of	suicide	when	victimized	(Afe	et	al.,	2016,	2017;	
Darves-Bornoz	et	al.,	1995;	Khalifeh	et	al.,	2015;	Kim	
et al., 2006). Kim et al. (2006), discovered a higher risk 
of suicidal attempts among abused patients compared 
to	 non-abused	 patients.	 Darves-Bornoz	 et	 al.	 (1995)	
found	that	victimization	of	women	with	schizophrenia	
was associated with an elevated risk of suicidal attempts. 
Afe	et	al.	(2016)	claimed	that	victimization	increased	
the rates of suicide risks while Afe et al. (2017) empha-
sized	how	abuse	within	SMI	like	schizophrenia	raises	
the	incidence	of	suicide.	Lastly,	Khalifeh	et	al.	(2015),	
revealed that half of the women in their sample who 
were	coping	with	SMI	and	had	encountered	sexual	as-
sault went on to report instances of attempted suicide.
Age
	 Of	 the	 seven	 selected	 articles,	 five	 discussed	 the	
relationship	between	age	and	victimization.	Afe	et	al.	
(2016), found that the younger group had higher chanc-
es of reporting IPV than the general population. Afe et 
al. (2017), similarly showed a higher prevalence of IPV 
reports	within	adults	younger	than	40	years	old.	Yildi-
rim	et	al.	(2014)	discovered	that	patients	who	had	expe-
rienced	sexual	abuse	were	notably	younger	compared	
to	those	who	did	not	report	a	history	of	sexual	abuse.	
Leslie	et	al.	(2023)	indicated	that	younger	mothers	had	
a	higher	risk	for	an	ED	visit	for	interpersonal	violence.	
Lastly,	Darves-Bornoz	et	al.	(1995)	found	that	women	
with	 schizophrenia	were	more	 at	 risk	of	being	 raped	
during the end of adolescence and early adulthood. 
Unemployment/ Low Income
	 Five	 studies	 assessed	 victimization	 and	 its	 as-
sociation with unemployment/low income. Afe et 
al. (2016) found higher rates of IPV, more precisely 
verbal abuse among unemployed women. Afe et al. 
(2017) also found that participants’ unemployment 

status	 was	 linked	 with	 higher	 chances	 of	 experienc-
ing IPV. Indeed, women who were unemployed and 
had low or no income were found to have increased 
odds	of	experiencing	physical,	verbal	and	sexual	abuse	
from	their	partners	(Afe	et	al.,	2017).	Darves-Bornoz	
et	 al.	 (1995),	 also	 expressed	how	 low	 income	had	 an	
important	 role	 in	 sexual	 victimization.	 Leslie	 et	 al.	
(2023),	found	in	their	sample	that	women	who	expe-
rienced interpersonal violence were residing in low-
er-income neighbourhoods and were also more likely 
to	 have	 an	 ED	 visit	 for	 interpersonal	 violence.	 Last-
ly,	Khalifeh	 et	 al.	 (2015),	 indicated	 that	within	 their	
population	 who	 experienced	 domestic	 and	 sexual	
violence, 80% of the participants were unemployed. 

Discussion
	 The	objective	of	this	scoping	review	was	to	analyze	
the	existing	peer-reviewed	literature	on	sexual	and	IPV	
against	women	with	schizophrenia	 to	summarize	 the	
current	 state	of	knowledge	on	 this	 subject	 and	high-
light future research avenues. As shown through the 
seven selected studies in this scoping review, a strong 
association	was	 found	 between	 sexual	 violence,	 IPV,	
and	women	with	schizophrenia.	Across	four	studies,	it	
was	observed	that	women	diagnosed	with	schizophre-
nia	demonstrated	a	 significantly	higher	prevalence	of	
experiencing	 IPV	 compared	 to	 women	without	 this	
diagnosis	(Afe	et	al.,	2016,	2017;	Khalifeh	et	al.,	2015;	
Leslie	et	al.,	2023).	In	Leslie	et	al.'s	(2023)	study,	wom-
en	with	 schizophrenia	were	 ten	 times	more	 likely	 to	
experience	 IPV	when	pregnant.	 In	contrast,	 research	
by	Afe	et	al.	(2017)	and	Khalifeh	et	al.	(2015)	showed	
that	women	with	schizophrenia	were	twice	as	likely	to	
experience	IPV.	The	findings	from	the	three	remaining	
studies	pointed	toward	a	heightened	prevalence	of	sex-
ual	abuse	of	approximately	28%	among	women	diag-
nosed	with	schizophrenia	(Darves-Bornoz	et	al.,	1995;	
Kim	et	al.,	2006;	Yildirim	et	al.,	2014).	This	highlights	
how	 women	 with	 schizophrenia	 are	 more	 likely	 to	
be	 victims	 of	 sexual	 and	 IPV.	Yet,	 this	 issue	 is	 rarely	
discussed by mental health professionals and physi-
cians creating a lack of awareness (Afe et al., 2017).
 Through the seven articles, various themes arose 
describing	 the	 risk	 factors	and	effect	of	victimization	
upon	 women	 with	 schizophrenia.	 Regarding	 symp-
tomology, four articles found a relationship between 
IPV,	 sexual	 violence,	 and	 elevated	 psychopathology	
(Afe	 et	 al.,	 2016,	Darves-Bornoz	et	 al.,	 1995;	Kim	et	



11

VIOLENCE	AGAINST	WOMEN	WITH	SCHIZOPHRENIA

al.,	2006;	Yildirim	et	al.,	2014).	Studies	have	identified	
that	 instances	 of	 abuse	 and	 victimization	 contribute	
to heightened psychiatric symptoms in women. This 
is manifested through increased levels of depression, 
anxiety,	 dissociative	 expression,	 and	 hallucinations	
(Darves-Bornoz	et	al.,	1995;	Kim	et	al.,	2006;	Yildirim	
et	 al.,	 2014).	The	 amplification	of	 symptoms	 can	be	
attributed	 to	women’s	 response	 to	victimization	and	
having	 limited	 resources	 in	 a	 society	 that	 stigmatizes	
them (Chernomas et al., 2000). Furthermore, women 
not only face heightened psychiatric symptoms but 
also encounter physical health issues. Given that indi-
viduals	with	schizophrenia	confront	a	notably	shorter	
life	expectancy	than	the	general	population,	with	ap-
proximately	 90%	 of	 deaths	 attributed	 to	 physical	 ill-
nesses,	 it	becomes	apparent	 that	 sexual	and	IPV	play	
a role as contributing factors to the deterioration of 
health (Chernomas et al., 2000). This form of violence 
can	result	in	injuries,	gynecological	problems,	and	com-
promised immune function, thereby intensifying the 
overall	health	challenges	experienced	by	these	women	
(Chernomas et al., 2000; Seeman, 2018). Conversely, 
Afe et al. (2017) demonstrated that individuals who 
do not comply with treatment and show symptom 
improvement are at a higher risk of IPV. This counter-
intuitive	finding	 suggests	 the	need	 to	 further	explore	
the	repercussions	of	victimization	on	symptomology.	
	 Among	 the	 seven	 articles	 analyzed,	 five	 studies	
(Afe	 et	 al.,	 2016,	 2017;	 Darves-Bornoz	 et	 al.,	 1995;	
Khalifeh	 et	 al.,	 2015;	 Kim	 et	 al.,	 2006)	 investigated	
the	relationship	between	victimization	and	the	risk	of	
suicide. In each instance, there was a uniform obser-
vation of an increased risk of suicide. Given that sui-
cide	 is	more	prevalent	 in	women	with	 schizophrenia	
compared to the general population (Seeman, 2018), 
research indicates that suicidal behaviour increases 
during acute social crises. Crucial predictive factors for 
suicide	in	women	with	schizophrenia	include	a	history	
of	 sexual	 abuse,	 IPV,	 and	 the	 loss	 of	 children	 (Carl-
borg et al., 2010). These traumatic events also have re-
percussions on women’s psychiatric symptoms, with 
depression	 and	 hopelessness	 identified	 as	 significant	
contributing risk factors to suicide (Carlborg et al., 
2010).	In	schizophrenia,	the	risk	factors	for	suicide	ap-
pear to be less associated with typical core symptoms 
of psychosis, such as delusions and hallucinations, 
and more linked to depressive symptoms, including 
agitation, hopelessness, and feelings of worthless-

ness (Carlborg et al., 2010). Consequently, as suicide 
risk	 is	 already	 high	 among	 people	 with	 schizophre-
nia,	 victimization	 exacerbates	 their	 situation,	 leading	
to an even higher likelihood of committing suicide.
	 Additionally,	an	increased	likelihood	of	experienc-
ing	sexual	and	IPV	during	younger	years	was	found	in	
five	studies	(Afe	et	al.,	2016,	2017;	Darves-Bornoz	et	
al.,	1995;	Leslie	et	al.,	2023;	Yildirim	et	al.,	2014).	The	
vulnerability	 of	 younger	 women	with	 schizophrenia	
may stem from the decline in social skills and cognition 
linked to the chronicity of the illness (Afe et al., 2017). 
Younger	women	also	 tend	 to	be	more	dependent	on	
their partner, increasing their risk of IPV, especially 
among women with SMI (Afe et al., 2017). Regard-
ing employment, unemployed or low-income women 
with	schizophrenia	were	more	 likely	 to	be	victims	of	
sexual	and	IPV	(Afe	et	al.,	2016,	2017;	Darves-Bornoz	
et	al.,	1995;	Khalifeh	et	al.,	2015;	Leslie	et	al.,	2023).	As	
the study of Afe et al. (2017) pointed out, individuals 
with	schizophrenia	are	more	likely	to	have	a	lower	so-
cioeconomic	status	due	to	the	debilitating	effect	of	the	
illness on their cognition, social skills, and ability to be 
productive.	Moreover,	barriers	still	exist	regarding	em-
ployment and the improvement of the socioeconomic 
status	of	people	with	schizophrenia	due	to	the	ongoing	
stigma and discrimination (Afe et al., 2017). Thus, this 
becomes	even	more	difficult	 for	women	with	 schizo-
phrenia	as	gender	barriers	exist	(e.g.,	men	having	better	
economic opportunities, more education, and more 
employment opportunities) (Afe et al., 2017). Given 
that	 employment	offers	 substantial	 support,	 contrib-
utes	 to	 a	dignified	 existence,	 and	 fosters	financial	 in-
dependence, it is noteworthy that many women with 
schizophrenia	lack	jobs	or	sufficient	income	(Afe	et	al.,	
2017). Consequently, these women face an increased 
likelihood	of	experiencing	violence,	primarily	attribut-
able to their socioeconomic status and lower income 
in comparison to the general population (Afe et al., 
2017). These results suggest that younger women diag-
nosed	with	schizophrenia,	particularly	those	with	low	
income and/or unemployed status, face an elevated risk 
of	becoming	victims	of	sexual	and	IPV.	This	victimiza-
tion,	in	turn,	amplifies	the	risk	of	suicide	and	height-
ened	psychopathology.	The	findings	also	suggest	that	
IPV	worsens	the	progression	of	schizophrenia,	leading	
to an increase in symptoms and a higher risk of suicide.
	 These	 findings	 underscore	 the	 need	 to	 enhance	
interventions that could better support women with 



12

schizophrenia	 experiencing	 sexual	 violence	 and	 IPV.	
Certainly, mental health professionals should rou-
tinely	inquire	about	IPV	among	women	with	schizo-
phrenia	to	identify	potential	victims.	By	making	both	
direct and indirect inquiries about IPV, clinicians can 
better detect IPV and develop comprehensive thera-
py plans that include social interventions to support 
women	 with	 schizophrenia.	 Additionally,	 clinicians	
need	to	be	aware	of	the	elevated	prevalence	of	sexual	
and physical abuse in this population. They should 
thoroughly evaluate psychosocial, familial, and clinical 
histories collectively (Kim et al., 2006). Studies have 
shown that clinicians can identify IPV risk and ad-
dress relationship dynamics, socioeconomic challeng-
es,	 and	pharmacological	 therapy	 effectively	 by	 giving	
proper attention to women's socio-demographic back-
ground, economic circumstances, and partners (Afe et 
al., 2017). Hence, the integration of regular violence 
screening and the establishment of a robust therapeu-
tic	rapport	with	clients	offers	health	professionals	a	vi-
tal opportunity for intervention to prevent severe phys-
ical, psychological, and social harm to these women.
 This review also denotes how the selected articles 
assessed women in the same age range (between 30 and 
40	years	old)	indicating	scarce	data	for	sexual	and	IPV	
among	women	with	schizophrenia	in	younger	and	el-
derly populations. As a result, it is recommended that 
forthcoming studies take into account diverse popu-
lations,	 sexual	diversity,	 and	gender	while	adopting	a	
non-binary	 perspective.	 Lastly,	 the	 selected	 studies,	
published	 between	 1995	 and	 2023,	 with	 a	 majority	
published	after	2013	(n=5),	suggest	a	recent	emergence	
of	reporting	sexual	and	IPV	incidences	against	women	
with	schizophrenia.	While	most	studies	were	cross-sec-
tional,	there	is	a	need	for	qualitative	and	mixed-method	
studies	 to	fully	understand	the	experience	of	women	
with	schizophrenia	to	prevent	and	protect	them	from	
sexual	and	IPV.	Overall,	this	scoping	review	reveals	that	
more studies are needed to improve our knowledge of 
sexual	 and	 IPV	 against	 women	 with	 schizophrenia.									
Study Limitations
 This scoping review has some limitations to 
consider. To begin, only peer-reviewed articles pub-
lished	 in	 scientific	 journals	 were	 included	 in	 this	 re-
view,	 excluding	 grey	 literature.	 The	 authors	 decided	
to	 exclude	 grey	 literature	 to	 prioritize	 the	 most	 rig-
orous reviewed and established research. This helps 
in providing a clearer picture of the current state of 

knowledge by ensuring the quality and reliability of 
the articles. Thus, this limited our ability to identify 
potential research and advance our understanding. 
Moreover, the study selection criteria restricted this 
review	to	English	and	French,	which	prevented	stud-
ies in other languages from being considered. Fur-
thermore, this research constrained its focus to adult 
women,	omitting	post-pubertal	schizophrenia	in	chil-
dren	and	young	adolescents.	Lastly,	the	chosen	articles	
lacked	clear	distinctions	between	sex	and	gender,	with	
a	 majority	 frequently	 remaining	 ambiguous	 about	
whether	 they	 were	 addressing	 gender,	 sex,	 or	 both.	
As such, studies in other languages, the inclusion of 
grey literature, and the inclusion of a broader popu-
lation	could	provide	further	insight	into	this	subject.	
Conclusion 
 The aim of this scoping review was to identify 
and	 synthesize	 literature	 on	 sexual	 and	 IPV	 against	
women	with	 schizophrenia.	The	 studies	 included	 in	
this	review	revealed	a	higher	prevalence	of	sexual	abuse	
and	 IPV	 among	 women	 with	 schizophrenia	 relative	
to	the	general	population.	The	findings	 indicate	that	
younger	 women	 diagnosed	 with	 schizophrenia,	 es-
pecially those with low income and/or unemployed 
status,	 are	 at	 an	 increased	 risk	of	 experiencing	 sexual	
and	 IPV.	This	 victimization,	 subsequently,	 raises	 the	
likelihood of suicide and heightened psychopathol-
ogy. These results underscore the necessity of foster-
ing interdisciplinary collaboration among health-
care professionals, social workers, and policymakers 
to	 effectively	 tackle	 IPV	 against	 women	 diagnosed	
with	 schizophrenia.	 While	 the	 retained	 articles	 for	
this review were small, there is a need for further in-
vestigation.	 Future	 research	 should	 explore	 current	
care setting interventions to prevent severe physical, 
psychological,	 and	 social	harm,	while	 also	 examining	
the	 impact	 of	 victimization	 on	 symptomatology	 as	
current	results	are	mixed.	Additional	research	should	
also	 explore	 childhood-onset	 psychosis	 and	 its	 asso-
ciation	 with	 sexual	 and	 intimate	 partner	 violence.

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comppsych.2014.08.049

BÉLISLE	ET.	AL



15

VIOLENCE	AGAINST	WOMEN	WITH	SCHIZOPHRENIA

Figure 1

Summary of the search strategy



16

BÉLISLE	ET.	AL

Figure 2

Flowchart of study selection and screening process 



17

VIOLENCE	AGAINST	WOMEN	WITH	SCHIZOPHRENIA

Table 1



18

BÉLISLE	ET.	AL

Table 1 (cont.)


