Acute and Long Term Mental Health Needs After Sexual Assault

Sexual assault is a profound psychological trauma that can significantly impact a victim-survivor’s mental health. Victim-survivors may experience a wide range of emotional, cognitive, and behavioral effects that appear immediately after the assault, weeks after, months, or even years after.^{1, 2} While everyone’s experience is different, understanding common mental health consequences, body-mind responses, and recovery options can help victim-survivors access support. 

Victim-survivors of sexual assault may experience psychological trauma that affects thoughts, emotions, identity, relationships, and overall health. While trauma responses vary, common reactions include but are not limited to: ^1-4

• Numbness
• Intrusive thoughts and flashbacks
• Night terrors 
• Difficulty opening up to others 
• Shame, guilt, and self-blame
• Depression 
• Anxiety
• Disordered eating 
• Emotional detachment and dissociation
• Hypervigilance
• Suicidal ideation
• Self-harm

Many victim-survivors struggle with these reactions and question whether their experiences are worthy of support. It’s important to recognize that all responses are valid, and all victim-survivors deserve care and support. 

Post-Traumatic Stress Disorder

A commonly reported mental health diagnosis after sexual assault is Post-Traumatic Stress Disorder (PTSD). PTSD can develop after experiencing or witnessing a life-threatening or deeply distressing event (like sexual assault). Not all survivors develop PTSD. Some may experience Acute Stress Disorder (ASD), Adjustment Disorder, and/or trauma-related anxiety and depression. According to the National Center for PTSD, around 94% of sexual assault victim-survivors experience symptoms of PTSD, with an estimated 30–50% going on to develop chronic PTSD.^3-4 

Symptoms of PTSD can include:

• Re-experiencing the trauma through flashbacks, nightmares, or intrusive thoughts.
• Avoidance of reminders, places, people, or situations associated with the trauma.
• Negative changes in thoughts and mood, including hopelessness, detachment, or distorted blame.
• Heightened arousal
• Irritability
• Difficulty concentrating

Complex Post-Traumatic Stress Disorder

For some survivors, including those who may have experienced child sexual assault (CSA), intimate partner violence, and/or repeated traumatic experiences may align with Complex PTSD (C-PTSD). Although C-PTSD is not officially recognized in the DSM-5 it is widely accepted throughout international diagnostic models.⁸ Therapies such as EMDR and trauma-focused CBT are often recommended for victim-survivors with C-PTSD Some symptoms of C-PTSD may overlap with PTSD, but have distinct features of C-PTSD include: 

• Difficulty regulating emotions
• Distorted self perception 
• Trouble with trust and intimacy
• Difficulty forming healthy attachments and problems maintaining healthy boundaries.   
• Chronic feelings of emptiness
• Chronic pain 

Minoritized victim-survivors of sexual assault such as BIPOC, LGBTQIA+ individuals, people with disabilities, immigrants, sex workers, and others often experience compounded trauma from systemic oppression, discrimination, and/or lack of access to culturally competent care and support.⁹ These intersecting barriers can worsen trauma and delay or prevent healing. All healthcare providers, including mental health professionals must acknowledge and affirm victim-survivor’s intersecting identities, past experiences, and cultural contexts. Culturally responsive and anti-oppressive therapy is critical to adequate and affirming support. 

The Body-Mind Connection

The effects of trauma are not just psychological, they live in the body. Survivors often experience somatic symptoms like headaches, fatigue, muscle tension, or stomach problems that have no clear medical explanation but are very real.

The body-mind connection refers to the intricate ways our nervous system, hormones, and immune responses interact with trauma:^{6, 7}

• Hyperarousal of the autonomic nervous system can keep the body in a state of fight-or-flight long after the threat is gone.
• Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis can disrupt sleep, appetite, and stress responses.
• Dissociation is a sense of disconnection from one’s body and emotions.
• Somatic flashbacks are when our body re-experiences physical sensations that occurred during a traumatic event.

Somatic-based therapies like sensorimotor psychotherapy, somatic experiencing, and/or trauma-sensitive yoga can help victim-survivors reconnect with their bodies.^{6, 7}

Long-Term Mental Health Effects¹⁰

Victim-survivors may continue to experience challenges that interfere with daily life functioning and relationships for months or years after the trauma. These can include:

• Depression including symptoms of persistent sadness, loss of interest, feelings of worthlessness
• Anxiety Disorders: including panic attacks, generalized anxiety, social anxiety
• Obsessive Compulsive Disorder (OCD) which can sometimes be triggered by a need for control post-trauma
• Eating Disorders: such as anorexia, bulimia, or binge eating that tends to be linked to body control 
• Self-harm and/or suicidal ideation

Longitudinal studies following sexual assault report that victim-survivors of sexual assault are three times more likely to suffer from major depressive disorder and over six times more likely to attempt suicide than non-survivors.^11-13 However, many survivors are able to heal after trauma. There are many national, local, and virtual resources available to help victim-survivors rebuild and move forward with a fulfilling and joyous life. It’s important to recognize that survivor’s mental health does often suffer after experiencing violence or abuse, but that there is hope beyond those struggles.

Sources

1. Dworkin, E. R., & Weaver, T. L. (2021). The impact of sociocultural contexts on mental health following sexual violence: A conceptual model. Psychology of violence, 11(5), 476. https://dx.doi.org/10.1037/vio0000350 
2. Campbell, R., Dworkin, E., & Cabral, G. (2009). An ecological model of the impact of sexual assault on women’s mental health. Trauma, Violence, & Abuse, 10(3), 225-246. https://doi.org/10.1177/1524838009334456 
3. Dworkin, E. R., Jaffe, A. E., Bedard-Gilligan, M., & Fitzpatrick, S. (2023). PTSD in the year following sexual assault: A meta-analysis of prospective studies. Trauma, Violence, & Abuse, 24(2), 497-514. https://doi.org/10.1177/1524838009334456 
4. Brooker, C., & Tocque, K. (2016). Mental health risk factors in sexual assault: What should Sexual Assault Referral Centre staff be aware of?. Journal of forensic and legal medicine, 40, 28-33. https://doi.org/10.1016/j.jflm.2016.01.028 
5. Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM‐IV and DSM‐5 criteria. Journal of traumatic stress, 26(5), 537-547. https://doi.org/10.1002/jts.21848 
6. Ulirsch, J. C., Ballina, L. E., Soward, A. C., Rossi, C., Hauda, W., Holbrook, D., & McLean, S. A. (2014). Pain and somatic symptoms are sequelae of sexual assault: results of a prospective longitudinal study. European journal of pain, 18(4), 559-566. https://doi.org/10.1002/j.1532-2149.2013.00395.x 
7. Jacobsen, S. A., Frostholm, L., Buhmann, C. B., Petersen, M. W., Ørnbøl, E., Dantoft, T. M., & Carstensen, T. B. W. (2023). Are sexual assaults related to functional somatic disorders? A cross-sectional study. International journal of environmental research and public health, 20(20), 6947. https://doi.org/10.3390/ijerph20206947 
8. Shatsky, S. M. (2025). Revising and Consolidating the DSM-5 and ICD-11 Post-Traumatic Stress Disorders Into a Dimensional Spectrum-Based Disorder: A Literature Review. https://doi.org/10.15760/honors.1643 
9. Scott, C. V., Singh, A. A., & Harris, J. C. (2023). The intersections of lived oppression and resilience: Sexual violence prevention for women of color on college campuses. In Intersections of identity and sexual violence on campus (pp. 119-139). Routledge. 
10. Turgumbayev, M., Shopabayev, B., Dzhansarayeva, R., Izbassova, A., & Beaver, K. (2023). An examination of associations between sexual assault and health problems, depression or suicidal ideation in a large nationally representative cohort of male and female 20-30-year-olds. Criminal behaviour and mental health : CBMH, 33(3), 196–212. https://doi.org/10.1002/cbm.2280
11. Bentivegna, F., & Patalay, P. (2022). The impact of sexual violence in mid-adolescence on mental health: a UK population-based longitudinal study. The lancet. Psychiatry, 9(11), 874–883. https://doi.org/10.1016/S2215-0366(22)00271-1 
12. Khadr, S., Clarke, V., Wellings, K., Villalta, L., Goddard, A., Welch, J., … & Viner, R. (2018). Mental and sexual health outcomes following sexual assault in adolescents: a prospective cohort study. The Lancet Child & Adolescent Health, 2(9), 654-665. https://doi.org/10.1016/S2352-4642(18)30202-5 
13. Li, J., Jin, Y., Xu, S. et al. Anxiety and Depression Symptoms among Youth Survivors of Childhood Sexual Abuse: A Network Analysis. BMC Psychol 11, 278 (2023). https://doi.org/10.1186/s40359-023-01275-3