The mental health effects of sexual assault and violence
Reviewed by Stephanie Steinman, PhD, CSAC
Written bytherapist.com team
Last updated: 10/11/2022
If you or a loved has experienced sexual assault or abuse, help is available now:
- RAINN National Sexual Assault Hotline: 800-656-HOPE (4673)
- RAINN Live Chat
What Is Sexual Assault?
Sexual assault is any type of sexual contact, behavior, or activity that occurs without the free and explicit consent of all parties. It can refer to different circumstances and terms, some of which carry specific legal connotations, such as:
- Rape: Rape is a legal term specifically referring to sexual penetration of any kind without consent.1
- Sexual abuse: Legally, sexual abuse refers to any type of sexual contact, behavior, or activity directed toward or forced upon a child or minor.
- Molestation: Molestation is another word for sexual assault. It is often used in reference to sexual abuse in particular.
- Incest: Incest refers to sexual contact, behavior, or activity between family. The term “family” in this case refers to people who are forbidden by law to marry because of blood or legal relation.
- Sexual harassment: According to the Equal Employment Opportunity Commission (EEOC), sexual harassment legally refers to “unwelcome sexual advances, requests for sexual favors, and other verbal or physical harassment of a sexual nature.”2
Sexual assault of any sort is a crime. It affects people physically, mentally, emotionally, and behaviorally. No one ever asks for or deserves sexual assault.
What Counts as Sexual Assault?
Sexual assault involves any sexual activity that is:
- Unwanted or coerced: Consent is the free, voluntary agreement to engage in sexual activity. It is often defined as an “enthusiastic yes.” If a person is pressured or forced into sexual behavior or activity, it is sexual assault. If a person initially says yes, but then says no, then consent is no longer present.
- Direct or indirect: When people think about sexual assault, they often think of direct examples, such as violent attacks. However, there are indirect forms of sexual assault as well, such as certain instances of sexual harassment including unwanted jokes or touching.
- Contact or noncontact: Not all forms of sexual assault include sexual or even physical contact. Pressuring or forcing a child to view pornogaphy online or publishing intimate photographs of an ex-partner without permission are examples of noncontact sexual assault.
- Attempted or successful: Attempted sexual assault of any kind is a crime, regardless of whether or not it is successful.
What Is Consent?
Consent is the key to a healthy sexual experience. Only adults who are not cognitively impaired by either substances or other health conditions can consent to sex. Minors categorically cannot consent to sex.
Consent is given in both explicit (verbal) and implicit (nonverbal) ways. A person’s body language may indicate consent, but unless it is accompanied by a verbal affirmation, it is not consent. Similarly, someone who says yes to sex verbally but whose body language makes it clear that they do not want to have sex, has not consented to sex.
Defining consent as an “enthusiastic yes” keeps in mind both the explicit (a verbal “yes”) and implicit (enthusiastic tone and body language) aspects of consent.
Remember, consent is not a one-time event. A person may consent to one sexual activity without consenting to another, or they may consent to sex one time without consenting to sex forever. Consent can also be revoked at any time before or during sexual activity. If coercion or threats take place, then consent cannot be freely given.
Sexual Assault Facts
According to RAINN (Rape, Abuse & Incest National Network), sexual assault is more common than many people assume.3 Certain demographic groups may be at greater risk than others:
- In the United States, one out of every six women—and one out of every 33 men—has been the victim of attempted or completed rape.
- Nine out of every 10 victims of rape are female.
- In 93% of child abuse cases, the child victim knew their abuser (over a third of which were family members).4
- Girls between the ages of 16 and 19 are four times more likely to be victims of sexual assault.
- About one in every five college students who identify as transgender, genderqueer, or gender nonconforming (nonbinary) has been sexually assaulted.5
- Indigenous Americans are twice as likely to experience sexual assault than other races, with a larger percentage committed by strangers (41%) than the general population (19.5%).6
- Only about one in three sexual assaults is reported to police.7 On average, only 25 perpetrators out of every 1,000 will be arrested, convicted, and incarcerated.
It’s important to note that people who are at greater risk of sexual assault do not carry any more responsibility for their assault than other victims—which is zero. Victims of sexual assault are never responsible for the crime that has been enacted against them.
Mental Health Effects of Sexual Assault
Posttraumatic Stress Disorder (PTSD)
Nearly one in three rape victims (31%) will develop posttraumatic stress disorder (PTSD) at some point in their lives, according to the National Violence Against Women Prevention Research Center (NVAWPRC).8 In comparison, only about 7% to 8% of the general population of the US develop PTSD over the course of their lives.9
PTSD is a common diagnosis among survivors of sexual assault because sexual assault is inherently traumatic. Trauma is an emotional response to a horrifying, stressful, or dangerous event, relationship, or circumstance that threatens or harms a person’s health and safety. Sexual assault of any kind is likely to elicit an emergency trauma response from your body, such as:
- Fight: Becoming aggressive, screaming
- Flight: Running away
- Freeze: Staying still, avoiding decisions, feeling numb or out of the body
- Fawn: Trying to please others to avoid conflict
It’s important to note that you have little say in how your body responds to trauma. No trauma response negates your experience as a victim of sexual assault.
For example, many people understand how someone might try to fight back (fight) or run away (flight) during a sexual assault. However, not fighting back (freeze) or trying to ingratiate yourself to your abuser (fawn) does not mean you gave consent to what was happening. It just means that your body exhibited a trauma response in an attempt to protect yourself.
The NVAWPRC also found that 30% of rape victims experienced at least one major depressive episode (MDE) in their lives.10 In comparison, only 10% of women in general experienced at least one MDE in their lifetime. Rape victims were also four times more likely to have experienced suicidal ideation and 13 times more likely than non-victims to have attempted suicide at least once.
If you or a loved one is struggling with depression or suicidal thoughts after sexual assault, help is available now:
- 988 Suicide & Crisis Lifeline: 988 or 1-800-273-TALK (8255)
- Crisis Text Line: Text HOME to 741741
Traumas like sexual assault can cause, affect, or even exacerbate other mental health disorders, including anxiety. Surviving a sexual assault can result in a state of hypervigilance. Hypervigilance is a form of anxiety in which a person lives their life constantly on guard as a way to protect themselves. Such levels of anxiety are unsustainable and can result in further psychological distress.
Evidence suggests that victims of sexual assault are at greater risk for substance abuse, which correlates with a greater risk for addiction.
Many people struggle to deal with the physical, mental, and emotional effects of surviving a sexual assault. Alcohol, drugs, and other addictive substances may seem like the only way to escape. If you or a loved one is struggling with addiction after sexual assault, help is available now:
- SAMHSA’s National Helpline: 1-800-662-HELP (4357)
- Alcoholics Anonymous (AA)
Sexual assault can affect a person physically, mentally, and emotionally. Common physical effects of sexual assault include:
- Sexually transmitted infections
- Fertility issues
- Chronic pain
- Undereating or overeating
It’s important to note that the physical effects of sexual assault can have psychological ramifications as well. An undesired pregnancy or issues with fertility, for example, could lead to anxiety or depression.
The Effects of Childhood Sexual Abuse
Childhood trauma of any kind can have long-lasting, negative effects on a person’s development. However, the effects of childhood sexual abuse can be particularly harmful. With one in nine girls (and one in 53 boys) experiencing sexual abuse before the age of 18 in the US, it is important to know how this devastating epidemic of abuse affects victims’ mental health well into adulthood.11
Experiencing sexual abuse can increase a child’s risk for:
- Memory loss
- Attachment disorder
- Oppositional defiant disorder (ODD)
- Conduct disorder
- Substance abuse
- Personality disorders
- Mood disorders
Trauma researcher and author Bessel van der Kolk, PhD, has proposed a new diagnosis for children with complex trauma histories known as developmental trauma disorder (DTD).12 This would condense many of the disorders listed above into a single diagnosis caused by childhood trauma, particularly childhood sexual abuse. It’s important to note that DTD is still being debated as a potential diagnosis and is therefore not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Healing Sexual Trauma
Get Help Now
If you or a loved one has experienced sexual assault or abuse, help is available now:
- RAINN National Sexual Assault Hotline: 800-656-HOPE (4673)
- RAINN Live Chat
The effects of sexual assault are long lasting. Even an assault or abuse that occurred years or decades ago can still affect a person today.
Survivors of sexual assault often benefit from therapy, medication, and other mental health treatment plans. If you are interested in seeking professional help regarding your experience of sexual assault or abuse, consider the following treatments:
- Cognitive behavioral therapy (CBT): Trauma-informed CBT can help survivors learn to identify unhelpful thought patterns that may have formed in response to their sexual assault. By understanding the root thinking behind your emotions and behaviors, you can make more helpful choices in the future.
- Prolonged exposure therapy: Exposure therapy gives survivors a chance to confront their traumatic memories and emotions in a safe, controlled environment.
- Eye movement desensitization and reprocessing (EMDR): With EMDR, survivors process their traumatic memories in a way that encourages new connections and rapid processing. If you cannot remember your sexual assault or abuse, EMDR may help you access some of those memories safely.
- Cognitive processing therapy (CPT): CPT was developed for and is often recommended to individuals suffering from PTSD, making it an ideal treatment option for survivors of sexual assault.
- Emotionally focused therapy (EFT): EFT draws on the fundamentals of attachment theory, family systems therapy, and gestalt therapy to help survivors restructure their emotional responses. This can help survivors strengthen relationships that may have been strained or broken in the aftermath of their assault.
- Medication: Survivors of sexual assault may benefit from certain medications, such as antidepressants or mood stabilizers, in conjunction with therapy. There are also medications that can help with sleep or nightmares.
Browse our directory to find a trauma-informed therapist near you.
8 Ways to Support Survivors
The effects of sexual assault and abuse often ripple out from the individual survivor, affecting their friends, family members, and community. If you have a loved one who recently survived a sexual assault or recently disclosed their past experience to you, here are some ways you can support them.
1. Believe Them
False reporting of sexual assault is statistically rare.13 However, many survivors face scrutiny, stigma, and even outright disbelief when they do report. This culture of scrutinizing the victim instead of the perpetrator contributes to the unfortunate statistic that an estimated 63% of sexual assaults are never even reported.
The baseline for support of sexual assault survivors is belief. If a friend or loved one shares their experience of sexual assault with you, believe them.
2. Don’t Blame Them
Sexual assault is never the fault of the victim. It doesn’t matter:
- What they were wearing
- What they were drinking
- Where they were
- What time of night they were out
- Whether they were flirting
- Whether they invited someone back to their place
Remember, consent is an “enthusiastic yes” that can be revoked at any time. Without consent, sex is always sexual assault.
3. Get Them to a Safe Place
Some experiences of sexual assault are ongoing, such as sexual abuse or molestation. If your friend or loved one is not physically or emotionally safe from their abuser, help them get to a safe space.
4. Help Them Seek Medical Treatment
If your friend or loved one has been physically injured, help them get to a doctor or emergency room for treatment. In addition to treating your friend’s injuries, a doctor may be able to collect some physical evidence of the assault that your friend may want to have available for future legal action.
5. Encourage Them to Seek Mental Health Treatment
Sexual assault harms people physically, mentally, and emotionally. Encourage your friend or loved one to seek treatment for their mental health in the same way they sought treatment for their physical health.
6. Help Them Seek Justice—if They Want to
There are many reasons people do not choose to report their sexual assault:
- Fear of retaliation
- Lack of trust in the police
- The pain of reliving the assault with every testimony
- Fear of other people learning of the sexual assault
- Worry that the perpetrator would never be convicted
Every victim has the right to file a police report, and if your friend or loved one wants to, you should encourage them to do so. But it’s important to understand that your friend may decide against reporting at this time.
7. Let Them Decide Who They Tell and When
If your friend or loved one confides in you, they may not have told anyone else. Many victims of sexual assault worry about how certain loved ones may react to their story, especially spouses, partners, or parents.
While you can encourage your friend that their community will love and support them no matter what, it’s ultimately their decision who they tell and when.
8. Let Them Heal at Their Own Pace
Healing after sexual trauma is not a linear process. Your friend or loved one may appear okay one day and deeply struggling the next. Some symptoms may disappear while others resurface.
It’s important not to rush your friend toward getting “back to normal” after their assault. Instead, help them discover their new normal while offering your love and support through both good days and bad.
About the author
The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.
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