The Mental Health Effects of Sexual Assault and Abuse

Sexual Assault / Abuse

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Sexual abuse is any form of sexual violence, including rape, child molestation, incest, and similar forms of non-consensual sexual contact. Most sexual abuse experts agree sexual abuse is never only about sex. Instead, it is often an attempt to gain power over victims.

Immediate crisis assistance after sexual assault can prove invaluable and even save lives, but therapy can also be helpful for those who experienced sexual abuse in the past. Some therapists specialize in addressing the trauma of sexual assault, and long-term assistance may be beneficial to some survivors of sexual abuse.

A number of organizations are available to help those who have survived sexual abuse. RAINN (Rape, Abuse & Incest National Network) offers an online hotline as well as a telephone crisis line. If you are in crisis or need to help someone who is, call RAINN now at (800) 656-HOPE. Most cities also offer rape crisis centers, which offer support, information, and counseling to survivors. To find your local center, click here.

Types of Sexual Assault and Abuse

Sexual abuse is common, particularly for women and girls: Ninety percent of all rapes are committed against women, with 1 in 6 women experiencing rape. One in five girls and one in 20 boys experience childhood sexual abuse.

Sexual abuse and sexual assault are umbrella terms used to refer to a number of sexual crimes. These crimes include:

  • Rape: Forced sexual contact with someone who does not or cannot consent. Forcing sex upon someone who does not want it, who is intoxicated, or who is not legally old enough to give consent all constitute rape. Though a handful of states specifically define rape as forcible sexual intercourse, any form of forcible sexual contact can have long-lasting effects on the victim, and most states now recognize forced oral sex and similar forms of assault as rape.
  • Child molestation: Child molestation is any sexual contact with a child. Many children who are molested are too young to know what is happening and may not fight back. Some abusers use the child's cooperation in these cases as "evidence" that no one was harmed. Examples of child molestation might include fondling or demanding sexual favors from a child.
  • Incest: Incest describes sexual contact between family members who are too closely related to marry. While incestuous sexual activity may occur between consenting adults, this is not common. The majority of all reported incest occurs as child abuse. Over a third of American sexual assault survivors under the age of 18 are abused by a family member, according to latest statistics. However, incest is an underreported crime, so the actual number of incest survivors may be higher.
  • Sexual assault: Non-consensual sexual contact with another person. Sexual assault includes behavior such as groping and any unwanted sexual touching. Attempted rape also falls into the category of sexual assault.
  • Other forms of sexual abuse: Not all sexual abuse fits neatly into common legal or psychological definitions. For instance, parents who have sex in front of their children or who make sexually inappropriate comments to their children are engaging in sexual abuse. So-called revenge pornography sites, which publish nude photos of victims without their consent, are another form of sexual abuse.

The laws governing sexual abuse are constantly changing. For this reason, most people who work with sexual abuse survivors rely on the victims' feelings, not the law, when determining whether a sexual assault has occurred. For example, marital rape can be deeply traumatic, especially in an otherwise abusive relationship. Yet marital rape did not become a crime anywhere until the 1970s, and it is still a challenging crime to prosecute.

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Sexual violence, including rape, harassment, and other forms of sexual assault, occurs in the United States military in high numbers: In 2014, nearly 5% of all women and 1% of all men on active duty reported experiencing at least one instance of sexual assault. However, sexual violence among service members is an under-reported crime, partially due to the retaliation and/or blame faced by many of the victims who do report the crime, and and it is estimated that only one in four victims of military sexual assault report their attacks.

Male Victims of Sexual Assault and Abuse

Because many people do not take the sexual assault of men seriously, believing that men, especially men who identify as heterosexual or who are assaulted by women, cannot be victims of rape, male victims of sexual abuse and assault often face a culture that tells them their abuse results from either weakness or homosexuality. Some are reluctant to label their assault as rape or abuse or even mention it at all. However, a reluctance to disclose may be a barrier to treatment, when treatment can often be of significant help in resolving the feelings of guilt, shame, fear, anger, and depression that might follow a sexual attack.

A man who is a member of the United States military is ten times more likely to be sexually assaulted than one who is not a service member, and more male service members are assaulted than are female service members. Most of these crimes are perpetrated out of a desire to dominate, to establish power and control over their "inferiors," not out of sexual desire. Although posttraumatic stress—which occurs as a result of sexual assault at almost twice the rate that it occurs as a result of combat, in men—is a highly treatable condition, many men do not seek treatment, self-harming or abusing drugs or alcohol to cope. It is estimated that 81% of male victims of military sexual trauma never report their attacks. Many men who do report their attacks and seek treatment are denied treatment, receive punitive charges, or are falsely diagnosed with mental health conditions and discharged to face potential homelessness and employment discrimination. Even when attacks are reported and go to trial, in only 7% of cases is the attacker convicted and punished.

Sexual Assault in the LGBTQ Community

Sexual violence, including rape and other forms of assault, is reported to occur in the LGBTQ community at a rate that is the same or higher than the rate of sexual violence among those who identify as heterosexual. However, sexual crimes in the LGBTQ community are often not reported, since LGBTQ survivors of sexual violence often face heterosexism, homophobia, transphobia, a discriminatory legal system, and other concerns, should they come forward and report an attack. Some of these concerns might include inadequate health and mental health care services; a fear of ostracism, both from the LGBTQ community as well as society; or a fear of being forced to come out—reveal their gender identity or sexual orientation—in order to make charges. LGBTQ survivors also face the same difficulties faced by anyone who reports a rape or other sexual crime, such as victim-blaming and disbelief.

Societal myths and stigmatization surrounding the identity and sexual practices of LGBTQ individuals may also contribute to a reluctance to report for fear of being further objectified, stigmatized, or disbelieved. Hate crimes also account for a significant number of the sexual assaults experienced by the LGBTQ community, especially among transgender people; 64% of all transgender people report experiencing sexual assault at least once in their lifetime. Between 30 and 35% of these assaults occur while in police custody or jail or at the hands of police officers or health care professionals.

Childhood Sexual Abuse

The sexual abuse of children can take many forms and includes behaviors where there is no physical contact, such as exposure or voyeurism. Childhood sexual abuse is common: Forty-four percent of sexual assault victims are under the age of 18, and one in 10 children are abused before the age of 18. Although the abuse of children may, in some cases, stem from a sexual attraction to children, a perpetrator may also abuse a child in order to gain power over the child. A perpetrator will often also threaten or manipulate the child to prevent him or her from disclosing the abuse.

Up to 93% of children who have been sexually abused know their attackers, and over a third of the abusers are family members; therefore, programs that teach children to be wary of strangers will not help prevent all types of abuse. Approximately 73% of child victims do not disclose the abuse for a year or more, and 45% do not disclose it until more than five years have passed. Many victims of childhood sexual abuse never tell anyone about the abuse.

Some behavioral signs of abuse include:

Those who experienced sexual abuse as children are more likely to be sexually abused again later in life, abuse drugs or alcohol, experience an eating disorder, and have difficulty enjoying or engaging in intimate contact as an adult.

Mental Health Issues Resulting from Sexual Assault

Sexual abuse teaches victims that their bodies are not really their own. Victims often report feelings such as shame, terror, depression, and guilt, and many blame themselves for the assault. Some of the mental health challenges survivors of sexual abuse face include:

  • Depression: The loss of bodily autonomy is often difficult to cope with. It can create feelings of hopelessness, despondency, and lead to diminishment in one's sense of self-worth. These feelings can lead to depression that may range from mild and fleeting to intense and debilitating.
  • Anxiety: For many people who struggle with anxiety, the feelings have no clear source. But for sexual abuse survivors, the loss of bodily autonomy, coupled with the fear that the attack could happen again, can cause intense anxiety. Some may develop agoraphobia and become terrified to leave their homes. Others suffer panic attacks, symptoms of physical anxiety, or a chronic fear of the type of person who harmed them. Someone who was raped by a tall, fair-haired man with blue eyes may instinctively dislike, mistrust, or fear all men encountered who match that description.
  • Posttraumatic stress: Posttraumatic stress (PTSD) might be described in this case as anxiety, depression, and intense memories of the abuse. Intensely disruptive flashbacks may occur, and in some cases they might even cause an abuse survivor to lose track of surroundings. A related condition, complex posttraumatic stress (C-PTSD), yields symptoms of traditional PTSD as well as a chronic fear of abandonment. Some people with C-PTSD also experience personality disruptions.
  • Personality disruptions: Some evidence suggests that personality disruptions such as borderline personality can sometimes be the result of sexual abuse. The behavior associated with these personality disruptions could actually be an adaption to abuse. For instance, a characteristic of borderline personality is a fear of abandonment. While that fear might not make sense in adulthood, avoiding abandonment might have been what protected someone from childhood abuse.
  • Attachment disruptions: It can be challenging, particularly in children who have been abused, to form healthy attachments with others. Adults who were abused as children may experience insecure attachment patterns, struggle with intimacy, or be too eager to form close attachments.
  • Addiction: Research suggests that abuse survivors are 26 times more likely to use drugs. Drugs and alcohol can help numb the pain of abuse, but often, substance abuse can lead to the development of different concerns.
  • Triggers: Triggers are stimuli that remind survivors of the abuse they experienced. A rape victim whose attacker chewed spearmint gum might be triggered into a flashback by the smell of spearmint, for example. Though triggers vary widely, violence, subsequent abuse, and intense discussions of abuse are among the most common triggers.

Sexual abuse does not only leave psychological scars. It can also have long-lasting health consequences. A person who is assaulted may sustain bruises and cuts or more severe injuries such as knife wounds, sprained or broken bones, and torn or damaged genitals. Some victims develop sexually transmitted infections. Others may become pregnant as the result of an attack. Survivors may also experience health concerns such as chronic pain, sexual dysfunction, fertility problems, and decreased immunity, as well as other unexplained aches, pains, or illnesses.

Therapy for Sexual Assault and Abuse

Though sexual abuse is a traumatic and life-altering experience, recovery is possible. A compassionate therapist who understands trauma, especially sexual trauma, and its effects will often be able to help those who have experienced rape and other forms of sexual abuse. Research has consistently shown that the relationship between the therapist and the person in treatment is the most significant predictor of recovery. The following therapeutic approaches have proven especially effective:

  • Exposure therapy often works well when the sexual abuse results in a specific fear. For instance, a child sexual abuse victim who is afraid to go into the room where the abuse took place or who fears women who wear clothing similar to those worn by an abuser may benefit from such an approach.
  • Eye movement desensitization and reprocessing therapy (EMDR) uses subtle eye movements to help “rewire” the brain and change the way the survivor processes the abuse.
  • Cognitive behavioral therapy (CBT) can help survivors abandon maladaptive approaches. A man who was abused as a child, for instance, might be so afraid of intimacy that he avoids romantic relationships. CBT can help him uncover the automatic thoughts that cause him to avoid intimacy, enabling him to steadily work toward healthy relationships and behaviors.

Stigmatization of Sexual Assault Victims

Many advocates for sexual assault survivors argue that we live in a “rape culture,” where attitudes that promote and permit rape pervade. Only 32% of rapes are reported to the police, and many victims report that they are met with skepticism and blame when they discuss what has happened to them. Police officers, doctors, and family members may imply or outright state the victim's clothing, behavior, or choice of entertainment "invited" the attack. The result is a culture in which most perpetrators face few consequences: Only 2% of rapists ever serve a single day in prison.

Other myths about sexual assault can further isolate and stigmatize victims. Those myths include the notion that rape and sexual abuse are rare, that fighting off an attacker is easy, that having an orgasm during a violent attack means the victim actually wanted it, and that people with extensive sexual experience cannot be victimized. Some people continue to insist date rape is not a problem or marital rape is not really rape.

Incest is a highly stigmatized type of assault, and as a result, many survivors of incest feel ashamed, embarrassed, or guilty and never report the abuse. Others may not even know incest is a form of abuse. Many people believe incest is rare because it is not often reported or discussed. Increasing awareness about incest and its prevalence as a form of sexual assault may help reduce both stigmatization of survivors and its rate of occurrence. 

Because the topic of sexual abuse is both personal and traumatizing, many victims feel deeply ashamed. Media reports erroneously referring to rape as “sex" can contribute to this shame, as can insensitive comments from loved ones, rape myths, and other elements of rape culture. This sense of shame causes some victims to go years without telling anyone of their abuse—a decision often later used against them as evidence that the assault or abuse never occurred.

Raising Awareness about Sexual Abuse

A number of celebrities have attempted to raise awareness about sexual abuse. Perhaps most notable among them is singer-songwriter Tori Amos, who is herself a rape survivor. Amos is a spokesperson for RAINN, which offers a hotline to survivors and regularly hosts benefits designed to raise awareness and assist victims.

Writer Eve Ensler has repeatedly spoken on behalf of sexual abuse survivors, and her play, The Vagina Monologues, directly tackles these issues. Male celebrities have also spoken out against sexual abuse. Steve Carrell, Daniel Craig, and Seth Meyers recently appeared in a video about sexual violence.

If you want to raise awareness about sexual abuse and avoid being a part of rape culture, some simple steps to take include:

  • Believing loved ones who tell you they were abused. There is no benefit to making a false rape allegation, and statistics consistently show that rape and other forms of sexual abuse are underreported. The rate of false reports for these crimes is also lower than that associated with other crimes.
  • Avoiding making jokes about rape or using rape as a metaphor for minor suffering. “That test really raped me” can be triggering to rape victims.
  • Being mindful of triggering language and stimuli. When you talk about sexual abuse, be aware of the fact that one or more observers may be a victim.
  • Offering unconditional love and support to friends or family members who have survived an attack.
  • Using language that the victim is most comfortable with. Some prefer to be called survivors, since this highlights their triumph over the attack. Others feel that this language is patronizing. Be mindful of how you use language, and follow the victim's lead. A person who cannot say herself that she was raped may be made uncomfortable if you use the term to refer to his or her abuse.

Case Examples

  • Man abused by father concerned about his parenting ability: Rico, 34, is experiencing symptoms of depression and PTSD and admits to his wife that he has been having memories of being abused by his father. His wife tells him to “get over it," but Rico finds that he has great anxiety about showing affection for his son, who is four, and his wife is frustrated because of this. He is afraid to disclose this in therapy, worrying that the therapist will call social services, but he eventually discloses, saying that he wants to get better so he can be a good father. The therapist explains the rules of confidentiality and assures Rico that unless he actually abuses or neglects his son, his privacy is protected; thoughts and feelings are not reportable offenses. The therapist helps Rico achieve a catharsis of grief and the anger he has for his father and helps him clarify his sense of boundaries for himself and his own son. In addition, the therapist recommends that Rico's wife attend a joint therapy session, so that she can achieve a better understanding of the trauma he experienced.
  • Survivor of hate crime afraid to report campus sexual assault: Lyddie, 22, is taken to therapy by her best friend, Justine, who has just discovered that Lyddie has been cutting herself. Lyddie does not want to talk to the therapist at first and asks her friend to communicate for her. Justine tells the therapist that Lyddie told her she was sexually assaulted by three male students who questioned her sexual orientation and said that she only needed a "real man." The assault happened several weeks earlier and since then, Justine reports, Lyddie has broken up with her girlfriend, routinely skips class, has not been completing her schoolwork, and neglects meals and self-care. Justine leaves Lyddie with the therapist, and although Lyddie is still reluctant to speak at first, eventually she tells the therapist that she is afraid to report the crime, knowing that she is likely to be blamed for having had several drinks on the evening of the incident. She reports symptoms of posttraumatic stress, admitting that she has been skipping class out of fear of seeing her attackers. Lyddie also tells the therapist that she has not told her family of the attack, saying that her mother warned her she might become a victim of hate violence due to her "preferences." The therapist begins by stating that the attack was in no way Lyddie's fault and encourages her to report the attack and seek medical attention. She then begins to work with Lyddie to treat her PTSD and other symptoms. They also explore ways that Lyddie might discuss the attack with her ex-girlfriend, who Lyddie says was hurt and confused by the breakup, and with her family, when Lyddie feels ready to do so.


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Last updated: 03-08-2016

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