Sexual Assault Can Cause Long-Term Distress, but Healing Is Possible

Whether you were riveted by the Brett Kavanaugh hearings and Christine Blasey Ford’s testimony, have followed the #MeToo movement or the Bill Cosby trial, or all of the above, you’ve seen that sexual assault is being publicly discussed now more than ever.

While that can bring up painful memories for survivors, it can also be empowering and encourage them to share their stories.

However, just because the topic of sexual assault is in the spotlight, that doesn’t automatically dispel harmful myths about it.

“Survivors aren’t wrong when they think that if they go along during an assault and don’t speak up, they are less likely to be injured. Only the victim can evaluate the risks of active resistance or fighting back. But afterwards, others may judge the victim for their behavior before, during or after the assault. Sadly, it is still true that victims are often disbelieved, blamed or the experience is minimized. Speaking up is always brave,” says Lucy Berliner, M.S.W., director of the Harborview Center for Sexual Assault and Traumatic Stress.

Fear of not being believed could be part of why only 32.5 percent of rapes and sexual assaults were reported to law enforcement in 2015, according to the Bureau of Justice Statistics’s National Crime Victimization Survey. That’s a lower percentage than any other type of violent crime.

Yet, sexual assault is not a minor problem: The survey also estimates there were more than 431,000 cases of rape or sexual assault in the United States that same year.

Challenging misguided ideas about sexual assault — like the belief that survivors who wait to report are lying or mistaken — ultimately helps survivors heal and prevents problematic norms from propagating, says Emily Dworkin, Ph.D., a postdoctoral fellow at the University of Washington School of Medicine’s Center for the Study of Health and Risk Behaviors.

Most of us are familiar with sexual assault myths, one of which is that people who were assaulted, especially women, will be unable to completely recover from the experience. Here, we’re taking a deep dive into that assumption and explaining how trauma can rewire the brain — and how a combination of support, therapy and determination can heal it.

How sexual assault changes the brain’s fear response

Several parts of the brain that regulate emotion and memory go on high alert during and after a traumatic event, says Michele Bedard-Gilligan, Ph.D., a licensed clinical psychologist who treats patients with posttraumatic stress disorder (PTSD) and anxiety at University of Washington Medical Center-Roosevelt. 

This is just your brain doing what it evolved to do in order to keep you alive. For some survivors, this response may not last long. But for others, it may lead to fear leeching into their lives. As many as one-third of women who are assaulted will develop PTSD, says Dworkin.

In fact, people who have been assaulted or affected by other types of interpersonal violence experience mental illness at higher rates than people who have been through other types of trauma, like car crashes or natural disasters, Bedard-Gilligan says.

She gives an example: If you were assaulted by someone in a red car, whenever you see a red car — even if it’s a different model or something carlike but larger, such as a firetruck — all the feelings and fear associated with the assault might resurface in your mind and body. 

Because of how generalized and upsetting these fear responses can be, people may end up limiting their behavior and shutting off their thoughts and feelings in order to cope, Dworkin says. The may also develop beliefs that are detrimental to self-image. 

“People may believe that they’re somehow to blame for the trauma. That comes from the wish that it never had happened in the first place, so they think of ways they could have acted differently to prevent it — even though it isn’t their fault,” Dworkin says. “They may think, ‘I can’t trust myself, I’m totally damaged, anything bad could happen to me at any time.’ It can become pervasive in the way people see the world.”

It can also lead to mental health problems. A study Dworkin led found that experiencing sexual assault put people at higher risk for every kind of mental illness she studied — even those not typically associated with traumatic experiences, such as bipolar disorder and obsessive compulsive disorder. 

Helping survivors heal

How someone’s recovery progresses depends on the person. Women who already experience stress because they inhabit marginalized identities, like queer women and women of color, may find that trauma compounds that stress. But healing is possible, especially with help.

Shortly after the assault occurs, survivors can seek medical help at a hospital. In the Seattle area, they will be treated and examined by a sexual assault nurse examiner, or SANE nurse, who is specially trained to care for people who have been assaulted. SANE nurses provide emotional support and medical care and, if the patient wishes, will gather evidence for a police report.

Brief counseling shortly after the assault could help prevent chronic problems like PTSD from developing. Bedard-Gilligan is currently leading a study, called Project BRITE, to determine just that. 

If some time has passed and the survivor develops chronic issues, one of the most effective treatment approaches is cognitive behavioral therapy (CBT), both Bedard-Gilligan and Dworkin say. There are two main types of CBT that work best: prolonged exposure therapy and cognitive processing therapy. 

In prolonged exposure therapy, patients are guided as they confront the fears PTSD has made them avoid. This involves talking about the traumatic memories and unpleasant emotions instead of pushing them away, and directly engaging with triggers (like the red car). These practices retrain the brain to let go of fearful associations that were created in response to the assault.

Cognitive processing therapy involves identifying how trauma has changed the way someone thinks about themselves and the world and altering those thoughts to be more balanced. This could mean someone recognizing they aren’t to blame, that they aren’t weak or that what happened isn’t likely to happen again. 

It can also be helpful for survivors to seek support from close friends, family or another trusted individual who will listen without judgment, Dworkin says. Having someone who listens and provides a safe space for survivors to express how they’re feeling is an important part of the healing process. 

Overall, though, people do heal, perhaps more quickly than is commonly believed. Bedard-Gilligan, who has studied prolonged exposure therapy and cognitive processing therapy, says 70 to 80 percent of women lose their PTSD diagnosis after about 10 or 12 therapy sessions. 

“It’s not the case that having PTSD makes you suffer for life,” she says.

Working toward prevention

While treatment for sexual assault-related trauma is effective, experts hope that one day prevention will be more robust and will succeed in lower assault rates, thus making therapy less needed. 

“We’re better at treating the symptoms after they’ve developed, which is unfortunate,” Bedard-Gilligan says. 

One important aspect of preventing the mindset that enables sexual assault is dispelling myths. Sexual assault is typically thought of as something done to women by men, and this isn’t false: The Centers for Disease Control and Prevention reports that 1 in 3 women will experience sexual violence in her lifetime, and, though this data is controversial, many studies support the fact that women are more likely to be assaulted.

Yet, that’s not the whole picture. Men can also be victimized, as can people who identify as transgender or non-binary, and women can be perpetrators. 

It’s important to take all of this into consideration, Dworkin says, in order to fully understand the problem.

“Part of the problematic norm is that only women are victims; acknowledging it can happen to anyone can be powerful in challenging that. And if you believe men can’t be emotional or victims, that makes it harder for men to speak up and seek help,” she says.

Bystander intervention programs, like the UW’s Green Dot, also play a role in reinforcing community accountability for preventing assault — though it’s important they don’t teach people to be fearful, but rather to support and respect one another, Bedard-Gilligan says.

“You’re the one who knows what really happened and have to have confidence in that. I don’t encourage victims to expect the legal system to give them healing or resolution because it can’t. You’ve got to look to yourself and your own understanding of your experience for your healing,” Berliner says. “Focus on taking back yourself, your life and your self-respect.”

If you or someone you know has experienced sexual assault and is looking for help, here are a few organizations that offer guidance and services. 

• King County Sexual Assault Resource Center
• 24-hour resource line: 888-99-VOICE
• Harborview Center for Sexual Assault and Traumatic Stress, 206-744-1600
• National Sexual Assault Telephone Hotline, 800-656-HOPE (4673)
• Sexual Assault Resources from the University of Washington