PTSD: National Center for PTSD
Sexual Assault Against Females
Sexual Assault Against Females
Although anyone - men, women, and children - can be assaulted, this fact sheet will focus on adult female victims of sexual assault.
What is sexual assault?
Sexual assault is defined as any sort of sexual activity between two or more people in which one of the people is involved against his or her will.
The sexual activity involved in an assault can include many different experiences. Women can be the victims of unwanted touching, grabbing, oral sex, anal sex, sexual penetration with an object, and/or sexual intercourse.
There are a lot of ways that women can be involved in sexual activity against their will. The force used by the aggressor can be either physical or non-physical. Some women are forced or pressured into having sex with someone who has some form of authority over them (for example doctor, teacher, boss). Women can be bribed or manipulated into sexual activity against their will. Others may be unable to give their consent because they are under the influence of alcohol or drugs. In some cases, the sexual aggressor threatens to hurt the woman or people that she cares about. Finally, some assaults include physical force or violence.
Who commits sexual assaults?
Often, when we think about who commits sexual assault or rape, we imagine the aggressor is a stranger to the victim. Contrary to popular belief, sexual assault does not typically occur between strangers. The National Crime Victimization Survey, conducted by the U.S. Department of Justice, found that 76% of sexually assaulted women were attacked by a current or former husband, cohabitating partner, friend, or date. Strangers committed only 18% of the assaults that were reported in this survey (1).
How often do sexual assaults happen?
Estimating rates of sexual violence against women is a difficult task. Many factors stop women from reporting these crimes to police and to interviewers collecting statistics on the rate of crime in our country. Women may not want to report that they were assaulted because it is such a personal experience, because they blame themselves, because they are afraid of how others may react, and because they do not think it is useful to make such a report. However, there are statistics that demonstrate the magnitude of this problem in our country. For instance, a large-scale study conducted on several college campuses found that 20% of women reported that they had been raped in their lifetime (2). The National Crime Victimization Survey estimated that 500,000 sexual assaults occurred in the U.S. from 1992 to 1993. Of those assaults, about one third were completed rapes and an additional 28% were attempted rapes (3).
What happens to women after they are sexually assaulted?
After a sexual assault, women can experience a wide range of reactions. It is extremely important to note that there is no one pattern of response. Some women respond immediately, others may have delayed reactions. Some women are affected by the assault for a long time whereas others appear to recover rather quickly.
In the early stages, many women report feeling shock, confusion, anxiety, and/or numbness. Sometimes women will experience feelings of denial. In other words, they may not fully acknowledge what has happened to them or they may downplay the intensity of the experience. This reaction may be more common among women who are assaulted by someone they know.
What are some early reactions to sexual assault?
In the first few days and weeks following the assault, it is very normal for a woman to experience intense and sometimes unpredictable emotions. She may have repeated strong memories of the event that are difficult to ignore, and nightmares are not uncommon. Women also report having difficulty concentrating and sleeping, and they may feel jumpy or on edge. While these initial reactions are normal and expected, some women may experience severe, highly disruptive symptoms that make it incredibly difficult to function in the first month following the assault. When these problems disrupt the woman's daily life, and prevent her from seeking assistance or telling friends and family members, the woman may have Acute Stress Disorder (ASD). Symptoms of ASD include:
- Feeling numb and detached, like being in a daze or a dream, or feeling that the world is strange and unreal
- Difficulty remembering important parts of the assault
- Reliving the assault through repeated thoughts, memories, or nightmares
- Avoidance of things (places, thoughts, feelings) that remind the woman of the assault
- Anxiety or increased arousal (for example difficulty sleeping, concentrating, etc.)
- What are some other reactions that women have following a sexual assault?
Major Depressive Disorder (MDD)
Depression is a common reaction following sexual assault. Symptoms of MDD can include a depressed mood, an inability to enjoy things, difficulty sleeping, changes in patterns of sleeping and eating, problems in concentration and decision-making, feelings of guilt, hopelessness, and decreased self-esteem. Research suggests that almost one-third of all rape victims have at least one period of MDD during their lives. And for many of these women, the depression can last for a long period of time. Thoughts about suicide are also common. Studies estimate that one-third of women who are raped contemplate suicide, and 13% of rape victims actually attempt suicide (4).
Many victims of sexual assault report struggling with anger after the assault. Although this is a natural reaction to such a violating event, there is some research that suggests that prolonged, intense anger can interfere with the recovery process and further disrupt a woman's life.
Shame and guilt
These feelings are common reactions to sexual assault. Some women blame themselves for what has happened or feel shameful about being an assault victim. This reaction can be even stronger among women who are assaulted by someone that they know, or who do not receive support from their friends, family, or authorities following the incident. Shame and guilt can also get in the way of a woman's recovery by preventing her from telling others about what happened and getting assistance.
Social problems can sometimes arise following a sexual assault. A woman can experience problems in her marital relationship or in her friendships. Sometimes an assault survivor will be too anxious or depressed to want to participate in social activities. Many women report difficulty trusting others after the assault, so it can be difficult to develop new relationships. Performance at work and school can also be affected.
Sexual problems can be among the most long-standing problems experienced by women who are the victims of sexual assault. Women can be afraid of and try to avoid any sexual activity; they may experience an overall decrease in sexual interest and desire.
Alcohol and drug use
Substance abuse can sometimes become problematic for women who are the victims of assault. A large-scale study found that compared to non-victims, rape survivors were 3.4 times more likely to use marijuana, 6 times more likely to use cocaine, and 10 times more likely to use other major drugs (4). Often, women will report that they use these substances to control other symptoms related to their assault.
Posttraumatic Stress Disorder (PTSD) involves a pattern of symptoms that some individuals develop after experiencing a traumatic event such as sexual assault. Symptoms of PTSD include repeated thoughts of the assault; memories and nightmares; avoidance of thoughts, feelings, and situations related to the assault; and increased arousal (for example difficulty sleeping and concentrating, jumpiness, irritability). One study that examined PTSD symptoms among women who were raped found that 94% of women experienced these symptoms during the two weeks immediately following the rape (5). Nine months later, about 30% of the women were still reporting this pattern of symptoms (6). The National Women's Study reported that almost one-third of all rape victims develop PTSD sometime during their lives and 11% of rape victims currently suffer from the disorder (7).
Information for health care providers
Unfortunately, sexual assault is fairly prevalent in our society today. Survivors of sexual assault can experience a wide variety of symptoms, but they do not have to suffer in silence. Mental-health professionals can offer a number of effective treatments tailored to the individual woman's needs.
For information on how to assess for sexual trauma or create a safe atmosphere for your patients, see Sexual Trauma: Information for Women's Medical Providers.
- Tjaden, P., & Thoennes, N. (1998). Prevalence, Incidence, and Consequences of Violence Against Women: Findings From the National Violence Against Women Survey. National Institute of Justice Research in Brief. Retrieved from https://www.ncjrs.gov/pdffiles/172837.pdf
- Douglas, K. A., & Collins, J. L. (1997). Results from the 1995 national college health risk behavior survey. Journal of American College Health, 46, 55-67. doi: 10.1080/07448489709595589
- Bachman, R., & Saltzman, L. E. (1995). Violence against Women: Estimates from the Redesigned Survey. Bureau of Justice Statistics, Special Report. Retrieved from http://www.bjs.gov/content/pub/pdf/FEMVIED.PDF
- Kilpatrick DG, Edmunds CN, Seymour AK. Rape in America: A report to the nation. Arlington, VA: National Victim Center and Medical University of South Carolina; 1992. Retrieved from: http://www.victimsofcrime.org/docs/Reports%20and%20Studies/rape-in-america.pdf?sfvrsn=0
- Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455-475. doi: 10.1002/jts.2490050309
- Rothbaum, B. O. & Foa, E. B. (1992). Subtypes of posttraumatic stress disorder and duration of symptoms. In J. R. T. Davidson & E. B. Foa (Eds.) Posttraumatic Stress Disorder: DSM-IV and Beyond. American Psychiatric Press: Washington, DC. (pp. 23-36).
- Kilpatrick, D. G. (2000). The Mental Health Impact of Rape. National Violence Against Women Prevention Research Center. Retrieved from https://www.musc.edu/vawprevention/research/mentalimpact.shtml