According to RAINN (the Rape, Abuse & Incest National Network), an American is sexually assaulted every 92 seconds.

While victims are disproportionately women, one in 71 men will be raped at some point in their lives. Men are also more likely to be assaulted by a stranger, whereas women typically know their perpetrator from at least the acquaintance level.

The gender gap seen in adult victims dramatically decreases when looking at cases of childhood sexual abuse.

Sexual Assault in America

Before reaching the age of 18, one in four girls and one in six boys will be sexually abused. Despite the shocking statistics, the reported numbers are only part of the equation.

A significant portion of sexual assaults is not reported, in both children and adults.

The consequences of sexual assault, however, are largely seen in substance-abusing populations. The psychological turmoil brought on by unresolved trauma leads millions of survivors to begin abusing drugs.

While substance abuse is a major health concern in its own right, survivors using substances as a way of coping points to a deeper issue. These issues are often anxiety, depression, and PTSD.

By examining these conditions and taking sexual assault history into account, providers can modify treatment to address the specific needs of patients.


Experiencing anxiety is normal for most people.

Preparing for an exam, facing problems at work, and making life-changing decisions can cause anxiety to arise. However,  when these feelings of worry and fear become so severe they interfere with daily functioning, the symptoms become a sign of an anxiety disorder.

Those suffering from anxiety disorders can feel excessive worry or fear when there is no real catalyst. In this case, anxiety can hit at any time, not go away, and worsen over time.

Anxiety disorders are the most common mental illness in the United States, with more than 40 million adults suffering each year. While various factors play a role in the development of anxiety disorders, a history of sexual abuse and assault significantly correlates with the development of a lifelong diagnosis of an anxiety disorder.

Children who have or are currently suffering from sexual assault or abuse may exhibit anxiety in different ways. Common behaviors include:

  •  Fear that bad things might happen if they disclose the abuse.
  •  Avoidance of all subjects sexual in nature.
  •  Looking for ways to avoid future trauma in an attempt to control impending abuse.
  •  Frequent nightmares.
  •  Intrusive thoughts.
  •  Excessive worry about a future occurrence.
  •  Believing the genital area is damaged and/or dirty.
  •  Increased aggression or seductive behavior towards peers.
  •  Substance abuse.
  •  Self-harm.
  •  Dissociation.

If childhood sexual abuse goes untreated, these symptoms can be magnified in adulthood.


Anxiety disorders are often comorbid with depression, another common mental illness affecting almost 7 percent of American adults.

Unlike anxiety, depression is not a normal part of life. Symptoms are always a sign of a larger issue. All types of depressive disorders have common symptoms, including:

  •  Persistent sad, anxious, or “empty” moods.
  •  Sleeping too much or too little, middle of the night or early morning waking.
  •  Reduced appetite and weight loss, or increased appetite and weight gain.
  •  Loss of pleasure and interest in activities once enjoyed, including sex.
  •  Restlessness, irritability.
  •  Persistent physical symptoms (such as chronic pain or digestive issues) that do not respond to treatment.
  •  Difficulty concentrating, remembering, or making decisions.
  •  Fatigue or loss of energy.
  •  Feeling guilty, hopeless, or worthless.
  •  Thoughts of suicide or death.

Even though only 35 percent of those suffering from severe depression seek help, the majority fully recover through effective treatment.

However, depressive disorders pose a significant risk for suicide, with major depression accounting for 60 percent of suicides.

There are numerous factors involved with the development of depressive disorders, and while multiple factors are involved for some people, others can develop depression from a singular cause.

Biology, cognition, gender, comorbidity, medications, genetics, and life experiences all play roles in the development of depression.

In terms of situational factors, a significant link was found between a history of sexual abuse and assault and the diagnosis of a depressive disorder. The association between the two is strengthened when a history of rape was also present.

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is one of the most publicly misunderstood mental illnesses and is extremely complex in diagnosing.

At the core, PTSD is characterized by symptoms of avoidance and nervous system arousal following a traumatic event. However, both experiencing and witnessing the traumatic event could lead to PTSD.

The most common traumatic events leading to PTSD involve death, serious injury, and sexual violence.

Those diagnosed with PTSD can experience various symptoms, including:

  •  Intrusive thoughts or memories.
  •  Nightmares related to the traumatic event.
  •  Flashbacks.
  •  Psychological and physical reactivity to reminders of the traumatic event, such as an anniversary.
  •  Avoiding thoughts or feelings connected to the traumatic event.
  •  Avoiding people or situations connected to the traumatic event.
  •  Memory problems are exclusive to the event.
  •  Negative thoughts or beliefs about one’s self or the world.
  •  Distorted sense of blame related to the event.
  •  Being stuck in severe emotions related to the traumatic event.
  •  Severely reduced interest in activities enjoyed before the event.
  •  Feeling detached, isolated, or disconnected from others.
  •  Difficulty concentrating.
  •  Irritability.
  •  Difficulty falling or staying asleep.
  •  Hypervigilance.
  •  Being easily startled.
  •  Depersonalization, or disconnection from oneself.
  •  Derealization, or a sense that one’s surroundings are not real.

Similar to depression, there is a significant association with sexual abuse, assault, and the development of post-traumatic stress disorder, with a history of rape strengthening the association.

Experiencing a traumatic event and developing PTSD is heavily tied to developing a substance use disorder.

Women exposed to traumatic life events are at an increased risk for alcohol abuse, while both men and women reporting sexual abuse have higher rates of alcohol and drug use disorders compared to their male and female counterparts.

Experiencing trauma in childhood is also linked to substance use. Adolescent sexual assault victims are 4.5 times more likely to abuse or become dependent on alcohol and 9 times more likely to abuse or become dependent on hard drugs.

Substance Use Disorders

Substance Use Disorders cover a range of substances, including alcohol, cannabis, inhalants, stimulants, and tobacco.

To be diagnosed with a substance use disorder, an individual must exhibit behaviors that fall into four main categories:

  •  Impaired control
  •  Social impairment
  •  Risky use
  •  Pharmacological indicators

For many people suffering from substance use disorders, pharmacological indicators like tolerance and withdrawal are indicators of advanced addiction.

Undergoing withdrawal also qualified people for a secondary diagnosis of substance withdrawal.

Forty-eight and a half million Americans used illicit drugs or misused prescription drugs in 2016. Substance use also led to 63,000 overdose deaths the same year, with a significant portion involving prescription or illicit opioids.

While there are numerous risk factors for substance abuse and developing substance use disorders, sexual assault victims are at a significantly increased risk for the use and abuse of drugs.

The contrary is also true. There is a high prevalence of sexual assault among those struggling with substance abuse.

However, the use of substances is not only present following a trauma. Perpetrators often use drugs and alcohol as a means of incapacitating victims.

Known as “date rape,”perpetrators often mix drugs like marijuana, cocaine, tranquilizers, sleeping aids, or “club drugs” like Rohypnol and GHB to overpower a victim and interfere with the victim’s memory of the assault.

Despite stereotypes and beliefs about victims who drink alcohol, studies have found that alcohol consumption does not cause sexual assault. Rather, researchers found that in some cases, the desire to commit a sexual assault causes alcohol consumption.

Using Substances to Cope

Unfortunately, many sexual abuse and assault survivors turn to substances as a means of coping with unresolved trauma.

The risk of turning to substance use and developing a substance use disorder increases when the survivor suffers from PTSD following the assault.

The forensic medical exams conducted post-sexual assault have been found to increase emotional and psychological distress and exacerbate symptoms of posttraumatic stress. To mediate this and prevent substance use and abuse following an assault, video interventions have been developed to act as an acute post-assault intervention.

Treatment and Recovery

Experiencing sexual assault leaves survivors with emotional and psychological distress that often leads to the development of mental disorders. These consequences are seen in victims of all ages, regardless of gender.

However, many survivors don’t report or seek help following an assault.

For those who decide to disclose their sexual assault, the recipient of the disclosure can have a significant influence on the victim’s recovery. Receiving social support, or positive reactions can result in positive effects and a likelihood of recovery.

Woman with "Stop" written on her hand

However, the results are mixed. Social support can also have a neutral effect on victims, suggesting a deeper and more professional treatment is needed.

Negative social reactions, on the other hand, can result in a “second injury” for assault victims. This occurs when the victim’s community, society, family, and friends react negatively to the disclosure of sexual assault and reject or blame the victim.

Seeking treatment soon after experiencing sexual assault significantly influences recovery.

Not only does seeking treatment sooner rather than later decrease treatment time and lead to a quicker recovery, but it also decreases the risk of psychological distress symptoms becoming severe.

Early treatment can also prevent the increased use of illicit substances and suicidal ideation.

Sexual assault and related disorders (like anxiety, depression, and PTSD) are often treated through Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), Prolonged-Exposure Therapy (PE), and Eye-Movement Desensitization Reprocessing (EMDR).

Each of these treatments is trauma-focused and can benefit victims in many ways, including:

  •  Helping victims to calm and soothe themselves.
  •  Increasing awareness of, and access to, strengths and outside resources.
  •  Processing specific and/or trauma-related memories in a safe space.
  •  Challenging trauma-based thinking.
  •  Finding meaning in what happened and the event’s effects.
  •  Reducing symptoms of depression and anxiety.
  •  Increasing confidence.
  •  Regaining quality of life.
  •  Reducing and/or eliminating reactionary symptoms of PTSD.

Sexual assault survivors diagnosed with PTSD who also suffer from substance use disorders are more likely to be hospitalized than their non-PTSD counterparts.

While substance abuse treatment can be effective in reducing or eliminating the use and abuse of substances, trauma therapy is a vital part of treatment for this population.

If the trauma and following consequences are not addressed during substance use treatment, the victims are likely to fall back into old patterns and struggle to form a lasting recovery. By seeking treatment that addresses both the trauma and substance use, survivors can form healthy coping mechanisms to prevent further substance use.

The road to recovery is a long and hard one, but with the right treatment approach, recovery from both substance use and sexual assault is possible.

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