How Sexual Assault Causes PTSD in Its Victims

PTSD and Sexual Trauma

Although it is the most prevalent crime in the United States at present, sexual assaults remain woefully underreported and the true scope of the problem may be even more severe than estimates indicate. In fact, most American men and women will suffer some type of sexual assault during their lifetime, and the mental health implications of these crimes also remains understudied. What is known for certain at present is that while the crime does not rise to that of rape in terms of severity, sexual assault can have a number of adverse psychological effects on victims, including posttraumatic stress disorder (PTSD). The purpose of this paper is to review the relevant literature to identify the psychological effects of sexual assault and a discussion concerning whether sexual assault such as touch or words can lead to the development of PTSD. Finally, the paper provides a summary of the research and the key findings that emerged concerning these issues in the conclusion.

Review and Discussion

At present, sexual assaults are believed to be the most prevalent crimes in the US, yet also the most underreported. In spite of a number of important legislative initiatives, the current statistics about sexual assault indicate that far too many of these criminal acts remain unaddressed, underreported and poorly understood (Kuadli, 2022). What is known with any degree of certainty today is that there are nearly half million cases of sexual assault among victims aged 12 years and over in the United States each year (Sexual Assault, 2023). Moreover, a growing body of scholarship confirms that the victims of sexual assault frequently experience a wide array of emotional and physical effects that can persist indefinitely.

It is important, however, to operationalize the terms that are involved in order to gain a better understanding of the type of severity of the criminal acts that define sexual assault versus rape. On the one hand, the term sexual assault refers to “sexual contact or behavior that occurs without explicit consent of the victim” (Sexual Assault, 2023, para. 4). Some examples of sexual assault include fondling, unwanted sexual touching or forcing a victim to perform various sexual acts such as oral sex (Sexual Assault, 2023).

By contrast, although rape is a type of sexual assault, not all instances of sexual assault rise to the legal offense of rape. For instance, the authorities at the Rape, Abuse & Incest National Network (2023) report that, “The term rape is often used as a legal definition to specifically include sexual penetration without consent” (Sexual Assault, 2023, para. 3). While the definitions of rape vary by jurisdiction, the legal definition provided by Black’s Law Dictionary (1991) indicates that rape specifically includes penetration. In this regard, Black’s reports that, “[Rape is] the act of sexual intercourse committed by a man with and without her consent, committed when the woman’s resistance is overcome by force or fear, or under other prohibitive conditions” (p. 1260).

Based on the foregoing, it is clear that both sexual assault and rape exist along a continuum of severity which can have a significant corresponding effect on the likelihood of victims developing PTSD. In fact, the American Psychiatric Association (APA) includes sexual trauma among the most common causes of PTSD. For example, the APA notes that, “Posttraumatic stress disorder is a psychiatric disorder that may occur in people who have experienced a traumatic event [such as] sexual assault” (Overview of PTSD, 2023, para. 2), As discussed further below, many people may experience PTSD-like symptoms in the immediate aftermath of a traumatic event, but the formal diagnose of PTSD requires that the symptoms persist for a period of at least 3 months (Overview of PTSD, 2023).

The symptoms of PTSD are grouped into four categories as set forth in Table 1 below, but the specific symptoms in each category can differ in their severity.

Table 1

Symptoms of PTSD

Symptom

Description

Intrusion

Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are reliving the traumatic experience or seeing it before their eyes.

Avoidance

Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.

Alterations in cognition and mood

Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (a void of happiness or satisfaction).

Alterations in arousal and reactivity

Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one's surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.

Source: Overview of PTSD, 2023

Taken together, the symptoms of PTSD that are caused by sexual assault can have life-altering implications, especially when victims are reluctant to seek the professional mental health assistance they need due to stigma or fear of retribution by the perpetrator. As also discussed further below, however, the symptoms of PTSD can emerge at any time following a traumatic experience, including even years later, especially if specific circumstances trigger a recollection of the event. In addition, victims of sexual assault may also experience a number of other co-morbidities such as anxiety, depression and diminished self-esteem which can exacerbate the adverse effects of PTSD (Nobels et al., 2022). In this regard, the APA advises that, “PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems” (Overview of PTSD, 2023, para. 7). In other words, the PTSD that is typically caused by sexual assault is a complex construct that can last a lifetime that defies easy analysis or treatment and the prevalence of this problem may be far greater than current estimates indicate.

More troubling still, the adverse effects of the symptoms that are inducted by PTSD related to sexual assault can become a self-perpetuating phenomenon when victims engage in self-destructive behaviors such as substance abuse in response to their condition. For example, a study by Hahn et al. (2022) concluded that, “The co-occurrence of PTSD and alcohol use disorder (AUD) is common following sexual assault and associated with more severe symptomology and increased likelihood of sexual revictimization” (p. 107). Given the highly personal, intrusive and frequently violent nature of the crime, it is not surprising that the likelihood of victims developing PTSD following a sexual assault is greatly increased (Victims of Sexual Violence Statistics. 2023). Indeed, a study by Pijpers et al. (2022) unequivocally concluded that, “Sexual assault is associated with a high risk of developing PTSD” (p. 1). Indeed, this eventuality is fairly intuitive since sexual assault is such a fundamental and egregious attack on individuals’ physical and emotional well-being as well as their personal dignity and self-esteem.

While any type of traumatic experience can cause PTSD or PTSD-like symptoms, victims of sexual assault are especially vulnerable to developing PTSD and reexperiencing the episode when confronted with similar circumstances (Harris et al., 2021). Although these symptoms are typically more frequent and intense in the immediate aftermath of a sexual assault, especially in the presence of trigger words, touches or situations, they can occur at any time over an individual’s lifespan (Nobels et al., 2022; Pijpers et al.,2022). In this regard, the APA adds that, “People with PTSD may relive the event through flashbacks or nightmares; they may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as an accidental touch” (Overview of PTSD, 2023, para. 5). The risk of developing PTSD following a sexual assault is mediated somewhat, though, by individual resilience factors, and some victims experience far fewer PTSD-like symptoms than others, but this resilience does not completely prevent the recurrence of symptoms over time (Valdespino-Hayden et al., 2022).

Conclusion

From the victims’ perspective, there is likely little difference between sexual assault and rape when it is especially severe or violent in nature, and the research was consistent in showing that victims of sexual assault are at high risk of developing PTSD as a result of their experience. The research also showed that sexual assault is the most common crime in the U.S. today, but its precise prevalence remains unknown because it is also among the most underreported crimes. Nevertheless, it is clear that victims of sexual assault can suffer from a wide range of emotional and physical problems, including suicide in extreme instances. These findings underscore the need for additional research in this area and action on the part of public health and criminal justice authorities in preventing this crime in the first place.