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Impact of Sexual Abuse on Mental Health

Updated: Dec 10, 2022

Awareness of the prevalence and impact of sexual abuse has recently surged in the media following such events as the #MeToo movement and the testimony of Christine Blasey-Ford. In 2015 Chanel Miller laid bare the devastating impact of the sexual abuse she suffered in a powerful letter that she read to her attacker in court: “My independence, natural joy, gentleness, and steady lifestyle I had been enjoying became distorted beyond recognition. I became closed off, angry, self deprecating, tired, irritable, empty. The isolation at times was unbearable.” (1)

These stories give voice to the oftentimes silent suffering of sexual abuse survivors. Like Chanel Miller, many individuals who have been forced into non-consensual sexual acts, find themselves struggling with a vast array of confusing and painful experiences related to their sense of self, their bodies, and their relationships. Additionally, sexual abuse victims don’t always receive the support they need following the attack; police, family members, and friends may sometimes doubt or blame the survivor or may simply not know how to respond, which unfortunately adds another layer of trauma onto the initial experience.

In my own work with individuals who have been sexually abused I have been struck by how frequently clients have expressed surprise that their symptoms of depression, shame, and anxiety are typical responses to this form of trauma. Often, I hear the words, “But it wasn’t that bad.” This statement potently captures a common experience of dissonance between what survivors think they ‘should’ experience after an assault, especially in cases of date rape or when overt physical injury did not occur, and the intensity of their actual experience.

To make sense of this dissonance and of the large array of symptoms that can arise following sexual violence, it can be helpful to understand how the body and nervous system are impacted by a traumatic event. Anytime we encounter a frightening situation that we are powerless to stop, especially when it includes a violation of our bodies and/or a betrayal of trust, we experience an overwhelming activation of our nervous systems and a confusing disruption of our sense of safety and autonomy that continue to resonate and impact us after the event has ended. Although everyone’s experience is different, research has revealed that the trauma of sexual assault commonly leads to both short-term and long-term consequences.

Short-term effects

During an attack or a threatening situation, survival processes in the brain and nervous system take over (fight/flight/freeze); these responses are automatic and not consciously controlled. In many sexual assaults, the brain causes a ‘shut down’ which makes it difficult to move or speak. After the event, this ‘shut down’ experience may cause an individual to blame themselves for the attack or to feel weak and helpless because they were unable to fight back. If the assailant was a person who the survivor knew, she or he may feel at fault, which can lead to additional self-blame and guilt.

Immediately following the attack, the nervous system often remains primed for danger. Instead of returning to baseline, the nervous system may continue to operate in a fight, flight, or freeze mode, often overwhelming a person’s ability to calm themselves or to control their behavior or

reactions. For instance, many survivors report feeling disconnected from their bodies and struggling with feelings of terror, shame, rage and guilt. They may have nightmares and insomnia, find it difficult to concentrate, or be unable to go to school or work. Some people describe this as feeling like they have lost control of their bodies and emotions, or that they no longer recognize themselves.

Relationships also tend to suffer. After sexual violence, it may feel difficult, even impossible, to talk about what happened. This can lead to feeling alone and isolated. Additionally, uncontrolled feelings of anger sometimes erupt towards friends and family. In her statement, Chanel Miller reported, “It took me eight months to even talk about what happened. I could no longer connect with friends, with everyone around me. I would scream at my boyfriend, my own family whenever they brought this up.” (1)

Long-term effects

Although these initial symptoms usually diminish over a period of several months, long-term effects of the attack may linger for years as survivors continue to struggle with the loss of their previous way of being in the world. Research has shown that sexual abuse survivors are especially vulnerable to the following mental health conditions:

  • Depression: In the long-term feelings of disempowerment and loss may lead to depression. When depressed, survivors may have difficulty experiencing pleasure, feel hopeless about the future, and badly about themselves. Suicidal thoughts may also occur.

  • Anxiety: Survivors may continue to experience chronic feelings of fear. This may manifest as persistent worry, difficulty leaving the house, panic attacks, or inability to relax.

  • PTSD: Some people who experience sexual assault will continue to be assailed by intrusive memories of the event in the form of flashbacks or nightmares. They may try to avoid all reminders of the assault and feel constantly on guard.

  • Eating Disorders and Substance Addiction: In order to cope with the pain from the assault, many survivors turn to drugs and alcohol or unhealthy patterns of eating (such as bingeing, purging or eating very little). While drugs, alcohol, and disruptions in eating often help to numb overwhelming emotional experiences, in the long-term, they lead to other problems.Despite these negative outcomes, it is possible to heal following a sexual assault. One of the most devastating and dangerous impacts of an assault is the feeling of being isolated. In fact, long-term mental health consequences are less likely when a survivor receives adequate support and care immediately following the attack. It’s important for survivors to know that they are not alone, that they are not “broken” or “crazy”, that their experiences are real and make sense, and that support is available.


1. Stephens, J. (2019, September 4). Chanel Miller’s Victim Impact Statement: “You Don’t Know Me but You’ve Been Inside Me.” Retrieved from

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