Attentional bias toward emotional stimuli in drug-facilitated sexual assault survivors: A two-alternative free-viewing eye-tracking study

Abstract

Drug-Facilitated Sexual Assault (DFSA) survivors represent an under-researched clinical population that may constitute a distinct psychopathological profile among sexual assault survivors, as their experiences are often accompanied by confusion, memory impairment, and a lack of narrative coherence. This is the first study to investigate emotion-related attentional mechanisms in DFSA survivors using eye-tracking technology, as a window into broader cognitive processing. A clinical sample of 39 women who had experienced a recent, isolated sexual assault (19 DFSA, 20 non-DFSA) and 35 demographically matched non-exposed controls completed a free-viewing task while their eye movements were recorded. Participants viewed emotional images (threatening, happy, and neutral) paired with control neutral scenes. DFSA survivors showed a clear attentional bias toward threatening images during later attentional stages (engagement and sustained attention), while non-DFSA survivors did not exhibit significant modulation based on emotional content. Controls displayed typical emotion-driven attention, with sustained focus on happy stimuli. PTSD symptom clusters also influenced attentional patterns: greater avoidance was associated with reduced fixation time to emotional scenes, and dissociative symptoms with increased fixation time to neutral ones. These symptoms were more prevalent in the non-DFSA group. These findings suggest that attentional responses to emotional information vary according to assault typology and are shaped by specific PTSD symptom profiles. Clinically, this highlights the need for trauma interventions tailored to individual patterns of attention and emotional engagement. In particular, DFSA survivors may benefit from strategies that address threat sensitivity, while non-DFSA survivors may require approaches that promote emotional reconnection and reduce avoidance.