Although core symptoms of acquaintance rape victims are similar to those of stranger rape victims, both acknowledged and unacknowledged acquaintance rape victims are at greater risk for long-term behavioral, emotional, and cognitive symptoms and impairment due to the unique social-psychological context of sexual victimization by an acquaintance. Clinicians need to recognize that the pattern, duration, and intensity of a victim's response to acquaintance rape can be moderated by such factors as crime characteristics, coping styles, concurrent life stresses, premorbid histories, pre-existing personality variables, age at the time of assault, and response of social support networks. Women who fail to acknowledge an assault as rape experience considerable emotional distress despite their failure to acknowledge the abuse and to seek treatment. Such distress causes symptoms similar to those of post-traumatic stress disorder (PTSD), and the level of distress is compounded by the inability of unacknowledged acquaintance rape victims to recognize the source of what appears to them to be global distress. Given the conspiracy of silence involved in "hidden" rape, clinicians need to assess for the possibility of assault when female clients present for treatment with symptoms of anxiety, depression, and symptoms characteristic of PTSD. Clinicians also need to be sensitive when inquiring about sexual assault and rape history. Cognitive processes involved in attitudes and coping behavior of acquaintance rape victims are examined. Appendixes contain additional information on symptomatic responses to acquaintance rape in the context of assessment. 107 references