The Aftermath of Sexual Abuse: The Long-Term Effects We Need to Start Talking About

The mental, emotional, and physical effects last long after the actual trauma.

Medically reviewed in September 2021

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One out of every six American women will experience some form of attempted or completed rape in their lifetime, according to the Rape, Abuse & Incest National Network (RAINN). And every eight minutes, a child is sexually abused in the United States. Despite the prevalence, only 6 out of 1,000 perpetrators will actually end up in prison, RAINN notes.

Sexual abuse is any unwanted sexual activity that involves force, threats, or taking advantage of someone who is not able to give consent. It is never the fault of the abused.

While there are a number of urgent issues a person may be forced to deal with following sexual trauma—including bruising, bleeding, sexually transmitted infections, broken bones, and pregnancy—the physical and mental effects of trauma can last for years afterwards.

“When we are under stressful conditions, such as experiencing abuse, our bodies secrete stress hormones which can predispose us to a variety of potential medical issues,” says psychologist Christopher Rossilli, PsyD, of Orange Park Medical Center in Jacksonville, Florida.

Remember: Although it may take years to recover from trauma, you shouldn’t have to feel alone through your healing process. Learn more about the potential long-term effects of sexual abuse, plus where to go for help.

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It’s completely normal to experience anxiety following abuse. If these feelings don’t subside after a month, however, or they start to affect your day-to-day life, you may have post-traumatic stress disorder (PTSD). It’s a type of anxiety disorder that can occur after an upsetting event.

Symptoms can vary, but some of the most common include:

  • Experiencing flashbacks
  • Avoiding activities that remind you of the traumatic experience
  • Losing interest in activities you once enjoyed
  • Consistently feeling like you’re on edge
  • Having difficulty sleeping or bad dreams
  • Becoming easily frightened
  • Being prone to angry outbursts
  • Harboring negative thoughts

There are a variety of treatments for PTSD. Psychotherapy, also called talk therapy, involves working with a mental health professional to shift your thought processes and behavior to better manage your feelings. During sessions, you and your therapist may talk about how to recognize guilt and shame following a traumatic event. A therapist can also help you develop relaxation techniques and determine whether antidepressants or medications that treat anxiety would be helpful to you.

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It’s possible to relive traumatic events through flashbacks, which occur when vivid memories resurface in your mind. Flashbacks can be triggered by someone’s voice, odor, or actions. They can occur at any time.

If you’re experiencing a flashback, RAINN suggests these ways to calm your mind in the moment:

Take deep breaths. Place your hand on your stomach. Make sure that it’s moving up and down as you slowly inhale and exhale.

Remind yourself it’s just a flashback. Even though it may seem like you’re back in the moment with the perpetrator, remember that you’re not. The abuse is over and you are alive.

Use your five senses. Snapping out of a flashback is easier said than done, but it can help to do the following:

  • Look around and take note of things you see, like furniture, artwork, and people. 
  • Breathe in and focus on the smells around you.
  • Listen to ambient noises or turn on some music.
  • Eat or drink something. Focus on the flavors of one of your favorite beverages or foods.
  • Hold something hot or cold and note what it feels like in your hand.

Understanding the warning signs and triggers of flashbacks—like being at a party or around a friend of the perpetrator—may help you better manage them.

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It’s normal to have feelings of sadness and hopelessness following sexual abuse. But if these feelings continue for two weeks or more and affect your day-to-day activities, it could be depression.

While depression can be triggered in part by your family history, biology, and environment, some of the biggest risk factors are major life changes, trauma, and stress. If you’re experiencing any of these symptoms every day for at least two weeks, it’s important to seek help from a mental health professional:

  • Sadness
  • Hopelessness
  • Loss of interest in things you once found enjoyable
  • Irritability
  • Feelings of guilt
  • Anxiety
  • Fatigue
  • Restlessness
  • Changes in appetite or weight

The good news is there are many treatments available. Antidepressants and talk therapy are the most common. Self-management techniques like exercise, goal setting, and socializing can also help.

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Substance abuse

While it may seem like using alcohol and drugs can help you escape the pain of a traumatic event, doing so can make things worse. Some signs of substance abuse include:

  • Spending lots of time with others who are also abusing alcohol and drugs
  • Stealing money from friends or family members to buy alcohol or drugs
  • Avoiding activities you once enjoyed because they don’t involve alcohol or drugs
  • Lying about substance abuse
  • Driving while under the influence of alcohol or drugs
  • Taking risks in order to get alcohol or drugs
  • Substance withdrawal
  • Drinking or using drugs more often than you want to

If you or someone you know is abusing alcohol or drugs, there are many ways to get help. You can find a local behavioral health treatment center through the Substance Abuse and Mental Health Services Administration, or you can call the hotline 24/7 at 800-662-4357.

Treatment programs can be for individuals or in group settings. They may involve cognitive behavioral therapy, motivational lessons, or 12-step facilitation therapies (such as Alcoholics Anonymous). For younger survivors, families are usually involved during treatment, as well.

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Painful feelings left over from serious trauma may lead to self-harm or self-injury, such as biting, burning, cutting, or scratching. Some survivors say they harm themselves because it helps numb the pain, releases feelings, and makes them feel in control. The reality is that relief is only short-term and often leads to repeated episodes of self-harm, which can result in skin damage, infections, other severe medical issues, or even death. If you feel the urge to hurt yourself, try to:

  • Put the object you were going to use for self-harm in another room and out of sight.
  • Take a walk outside.
  • Text a friend or family member about anything that’s on your mind.

You may also try to distract yourself from the impulse by taking a shower or a bath (making sure all razors are removed from the area) or rubbing an ice cube across the area you were planning to harm.

If you’re having a difficult time controlling the inclination to hurt yourself, the Self-injury Outreach & Support website can help. The organization provides personal stories from survivors, resources to help you cope with self-harm tendencies (both long-term and in the moment), and information for family members or educators to help.

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Sleep disorders

It can be difficult to sleep after a traumatic event, especially if it took place in a bedroom. Even if it didn’t, people who have been sexually abused may experience trouble falling and staying asleep or urges to sleep in the middle of the day. Nightmares and sleep terrors are also common, as are serious conditions like chronic insomnia (defined as having difficulty falling or staying asleep three or more nights per week for at least a month).

If you’re having sleep problems or feeling so tired during the day that it interferes with your activities, see your healthcare provider (HCP). There are many ways to improve your sleeping habits, such as adopting a healthy bedtime routine, reducing screen time before bed, and limiting caffeine.

If you’re diagnosed with insomnia, there are treatment options to try. Relaxation training may include progressive muscle relaxation, breathing exercises, meditation, or mindfulness. Cognitive behavioral therapy, which helps survivors work through problems by reframing thoughts and changing behavior, can also help. Your HCP may also recommend prescriptions or over-the-counter medications.

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Suicidal thoughts may cross survivors’ minds, and the longer the abuse occurs, the greater the risk of suicide. Many studies show that those who were sexually abused during childhood or adolescence are more likely to attempt suicide than those who were not abused. Get help if you experience these signs:

  • Talking about wanting to die or kill yourself
  • Searching online for ways to kill yourself, or how to buy a gun
  • Discussing feelings of hopelessness or having no reason to live
  • Feeling trapped or like you’re in intolerable pain
  • Using increasing amounts of drugs or alcohol
  • Anxiety, agitation, and acting out recklessly
  • Changes in sleep
  • Isolating or withdrawing yourself
  • Extreme mood swings

If you or someone you know is contemplating suicide and is in immediate danger, call 911 right away. You can also chat with a counselor at the Lifeline Crisis Chat or the confidential National Suicide Prevention Lifeline at 800-273-8255. Crisis workers are there to listen, understand, and provide resources to help you work through these feelings.

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Be patient during the healing process

Recovering and healing from sexual abuse can take a long time, and some feelings and emotions may stay with you the rest of your life, says Rossilli—but that’s okay. They key is to seek treatment.

“I’ve lost count of the number of people who come to me in their 40s, 50s, and 60s who essentially had no treatment,” he says. “No treatment means no healing.” When the healing process doesn’t take place, the invisible emotional wounds are left open, he adds.

Rossilli recommends finding a psychologist or counselor who you can really connect with. “It’s likely you’re going to have some trust issues after being abused,” he notes, “so finding someone you can talk to openly is really beneficial.”

Sources: “Statistics.” 2021. Accessed April 27, 2021.
American Psychological Association. “Sexual Abuse.” 2021. Accessed April 27, 2021.
Joyful Heart Foundation. “Effects of Sexual Assault and Rape.” 2021. Accessed April 27, 2021. “Post-Traumatic Stress Disorder.” 2021. Accessed April 27, 2021.
National Institute of Mental Health. “Post-Traumatic Stress Disorder.” May 2019. Accessed April 27, 2021. “Flashbacks.” 2021. Accessed April 27, 2021. “Depression.” 2021. Accessed April 27, 2021.
National Institute of Mental Health. “Depression.” May 2019. Accessed April 27, 2021. “Behavioral Health Treatments and Services.” April 21, 2020. Accessed April 27, 2021. “Self-Harm.” 2021. Accessed April 27, 2021.
SiOS: Self-Inury Outreach & Support. “Welcome.” 2021. Accessed April 27, 2021.
National Suicide Prevention Lifeline. “Talk to Someone Now.” 2021. Accessed April 27, 2021. “Sleep Disorders.” 2021. Accessed April 27, 2021.
Sleep Foundation. “Insomnia.” September 4, 2020. Accessed April 27, 2021.
PsychCentral. “In-Depth: Cognitive Behavioral Therapy.” May 17, 2016. Accessed April 27, 2021.

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