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EMOTIONAL AND PHYSICAL
EFFECTS OF SEXUAL ASSAULT
INTRODUCTION
Any abuse or neglect in childhood has profound, lifelong consequences on both the
physical and mental health of victims. Sexual abuse is particularly destructive, as it is
“apparently more prevalent, and often more prolonged, than physical abuse.” 1 When a
child suffers both physical and sexual abuse, the effects are particularly severe. 2
Symptoms can include: major depression, adjustment disorder, alcohol or other
substance abuse, personality disorders, multiple personality, anxiety disorders,
psychotic disorders, and psychosexual dysfunctions. The following symptoms, when
presented together, are especially likely to indicate a history of sexual abuse:
compulsive sexual behavior, substance abuse, sadomasochistic fantasies, problems
with sexual identity, low energy or chronic fatigue, and loss of interest in sex. 3
39% of attempted rapes and 17% of sexual assaults against females resulted in injured
victims.4
45% of injured female victims of a reported attempted rape compared to 22% of injured
victims of an unreported attempted rape received medical treatment. 5
EMOTIONAL/PSYCHOLOGICAL EFFECTS
BORDERLINE PERSONALITY DISORDER
More than 80% of women diagnosed with borderline personality disorder, a mental
illness characterized by impulsive behaviors including intense anger, suicidal
tendencies, self-mutilation, promiscuity and difficulties with relationships, report some
sort of childhood trauma: 6
1
Herman, Judith, Christopher Perry, and Bessel Van der Kolk. Childhood Trauma in Borderline Personality Disorder.
146(4) American Journal of Psychiatry (1989).
2 Bryer, J., et al. Childhood Sexual and Physical Abuse as Factors in Adult Psychiatric Illness. 144(11) American
Journal of Psychiatry (Nov. 1987).
3
Steiner Crane, et al. Prevalence of a History of Sexual Abuse Among Female Psychiatric Patients in a State
Hospital System 39(3) Hospital and Community Psychiatry (March 1988).
4 Bureau of Justice Statistcs. U.S. Department of Justice. 2002. Rape and Sexual Assault: Reporting to Police and
Medical Attention, 1992-2000.
5 Ibid.
6 Herman, 1989.
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71% report physical abuse;
68% report sexual abuse;
62% report having witnessed domestic violence.
Women diagnosed with borderline personality disorder are: 7
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Three to four times more likely to have been child sexual abuse victims, in
particular victims of sexual abuse by their fathers, than women diagnosed with
other psychiatric disorders;
70% of the women who had been abused by their fathers had also been abused
by others; and 80% had been physically abused as well;
Many were also neglected by their mothers.
Sexual abuse is an important, independent risk factor for the development of borderline
personality disorder in male victims.8
DEPRESSION
As a result of the rape, victims are three times more likely than non-victims to
experience a major depressive episode in their lives (30%).
Depression may be the most frequent symptom in survivors of childhood sexual abuse. 9
EATING DISORDERS AND SELF-MUTILATION
In a 1996 survey of 6,000 adults, women with a history of sexual assault were
significantly more likely to report one or more symptoms of eating disorders than were
other women. Most strongly associated with eating disorder symptoms were sexual
assault during childhood, sexual assault by a parent, repeated assaults, coercion by
threat of withdrawing love, and completed sexual contact. 10
As many as 2/3 of sufferers of anorexia or bulimia have histories of child sexual
abuse.11
70% of child sexual abuse victims with bulimia had self-mutilated by overdosing,
poisoning, cutting or burning themselves, or by head banging. 12
7
Westen, Drew, Ph.D., et al. Physical and Sexual Abuse in Adolescent Girls with Borderline Personality Disorder.
60(1) American Jouranl of Orthopsychiatry (Jan. 1990).
8 Holmes, W. C., M.D., MSCE, and G.B. Slap, M.S., M.S. Sexual Abuse of Boys. 280(1) Journal of the American
Medical Association (1998): 1855-1862, citing numerous studies.
9 Green, Arthur H., M.D. Sexual Abuse: Immediate and Long-Term Effects and Intervention. 32(5) Journal of
American Academy of Child Adolescent Psychiatry (Sept. 1993).
10 Laws, Ami, and Jacqueline Golding. Sexual Assault History and Eating Disorder Symptoms Among White,
Hispanic, and African-American Women and Men. 86(4) American Journal of Public Health (1996): 579-582.
11 Herzog, D.B., et al. Childhood Sexual Abuse in Anorexia and Bulimia Nervosa: A Pilot Study. 32(5) Journal of
American Academy of Child Adolescent Psychiatry (Sept. 1993): 962-966.
12 Ibid.
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Adult survivors of child sexual abuse are more likely to suffer from obesity or morbid
obesity.13
HEALTH RISKS
Nearly 1/3 of all rape victims develop rape-related Post Traumatic Stress Disorder
(PTSD) in their lifetimes.14
Adult psychiatric problems associated with child abuse appear to be more severe when
the victim has experienced more than one type of abuse, such as both sexual and
physical abuse.15
Emotional and behavioral symptoms exhibited by adult survivors of child sexual abuse
can include: major depression, adjustment disorder, alcohol or other substance abuse,
personality disorders, multiple personality disorder and psychosexual dysfunctions. 16
Young adults with at least one incident of forced sex during childhood were far more
likely to engage in high-risk behaviors than were non-abused young people: 17
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They were four times more likely to engage in sex with strangers;
They were twice as likely to have multiple sexual partners;
The females were twice as likely to become pregnant before age 18;
The survivors were twice as likely to contract HIV.
The majority of women with histories of multiple types of abuse had twice the rates of
hospitalization than did non-abused women. Higher rates of surgery were also related
to multiple types of abuse.18
Physical and sexual dating violence against adolescent girls is associated with
increased risk of substance use, unhealthy weight control behaviors, sexual risk
behaviors, pregnancy, and suicidality.19
13
Drossman, D.A., et al. Sexual and Physical Abuse and Gastrointestinal Illness: Review and Recommendations.
123(10) Annals of Internal Medicine (Nov. 15, 1995): 782-794.
14 Kilpatrick D.G., C.N. Edmunds, and A. Seymour. 1992. Rape in America: A Report to the Nation. Arlington, VA:
National Victim Center.
15 Bryer, J., et al. Childhood Sexual and Physical Abuse as Factors in Adult Psychiatric Illness. 144(11) American
Journal of Psychiatry (Nov. 1987).
16 Steiner Crane, et al. Prevalence of a History of Sexual Abuse Among Female Psychiatric Patients in a State
Hospital System 39(3) Hospital and Community Psychiatry (March 1988).
17 Cunningham, R.M., et al. The Association of Physical and Sexual Abuse with HIV Risk Behaviors in Adolescence
and Young Adulthood: Implications for Public Health. 18(3) Child Abuse and Neglect (March 1994): 233-245.
18 Moeller, T., G. Bachman, and J. Moeller. The Combined Effects of Physical, Sexual and Emotional Abuse During
Childhood: Long-Term Health Consequences for Women. 17 Child Abuse and Neglect (1991): 623-640.
19 Silverman, Jay G. et al. Dating Violence Against Adolescent Girls and Associated Substance Use, Unhealthy
Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality. 286 (5) Journal of the American Medical
Association (2001): 572.
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POST TRAUMATIC STRESS DISORDER
Victims of sexual assault often suffer from rape trauma syndrome, a type of post
traumatic stress disorder (PTSD). Traumatic incidents, including military combat service
and violent crime, may cause post traumatic stress disorder. PTSD includes a range of
psychological distress: fear, emotional numbness, flashbacks, nightmares, obsessive
thoughts and anger. Post traumatic stress reactions can occur months or years after an
incident.
Sexual assault victims also suffer psychological reactions specifically related to sexual
assault. Victims may feel terrified of the offender and fear for their lives. Victims may
also feel humiliation, shame, and self-blame. If the assault is perpetrated by an
acquaintance, friend, or lover, violation of trust can be an issue for the victim. Because
of their shame and fear about how people will react, many victims keep the rape a
secret.
SUBSTANCE ABUSE
Compared to non-victims of crime, rape victims were:
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5.3 time more likely to have used prescription drugs non-medically;
6.4 times more likely to have used have used hard drugs;
3.4 times more likely to have used marijuana.20
70% of female substance abusers in treatment had histories of sexual abuse, vs. 12%
of the men in treatment.21
Sexual abuse survivors of both sexes were 70-80% more likely to report heavy alcohol
abuse, as well as excessive use of tranquilizers, than were non-abused adults.22
Sexually abused women started smoking about two years earlier than did other women
and were more likely to abuse other drugs as well.23
SUICIDE
Rape victims were 4.1 times more likely than non-crime victims to have contemplated
suicide and 13 times more likely to have made a suicide attempt. 24
20
Silverman, Jay G. et al. Dating Violence Against Adolescent Girls and Associated Substance Use, Unhealthy
Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality. 286 (5) Journal of the American Medical
Association (2001): 572.
21 Substance Abuse and the American Woman. The National Center on Addiction and Substance Abuse, Columbia
University (June 1996).
22 S. Zierler, et al. Adult Survivors of Childhood Sexual Abuse and Subsequent Risk of HIV Infection. 81(5) Amercan
Journal of Public Health (May 1991).
23 Health Consequences of Sexual Abuse. 9(7) The Harvard Mental Health Letter (Jan. 1993).
24 Ibid.
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56% of women in one study who reported child sexual abuse had a history of suicide
attempts.25
In a study surveying more than 3,000 women at 32 colleges and universities in the U.S.,
30% of the women who identified in the study as rape victims contemplated suicide
after the incident.26
Suicide rates among sexually abused males were from 15 to 14 times higher than
among other males.27
WOMEN WHO SEEK MENTAL HEALTH CARE
Almost 2/3 of outpatient mental health clinic clients reported having been abused as
children. Half were either physically abused, or both physically and sexually abused;
another 12% were sexually abused only.28
As many as 80% of women inpatients in psychiatric facilities report serious physical
and/or sexual abuse as children.29
PHYSICAL EFFECTS
HEALTH
Among victims raped since their 18th birthdays, 31.5 percent of the women, and 16.1
percent of the men, said they incurred an injury other than the rape itself during their
most recent rape.30 Of those females injured, 74% reported scratches, welts, or bruises
as the injury.
25
Beitchman, J.H., et al. A Review of the Long Term Effects of Child Sexual Abuse. 16(1) Child Abuse and Neglect
(1992): 101-118.
26 Warshaw, Robin. 1994. I Never Called it Rape: The Ms. Report on Recognizing, Fighting and Surviving Date &
Acquaintance Rape. New York: Harper Perennial: 66.
27 Holmes, W. C., M.D., MSCE, and G.B. Slap, M.S., Sexual Abuse of Boys. 280(1) Journal of the American Medical
Association (1998): 1855-1862, citing numerous studies.
28 Westen, Drew, Ph.D., et al. Physical and Sexual Abuse in Adolescent Girls with Borderline Personality Disorder.
60(1) American Jouranl of Orthopsychiatry (Jan. 1990).
29 Steiner Crane, et al. Prevalence of a History of Sexual Abuse Among Female Psychiatric Patients in a State
Hospital System 39(3) Hospital and Community Psychiatry (March 1988).
30 National Institute of Justice. 2006. Extent, Nature, and Consequences of Rape Victimization: Findings From the
National Violence Against Women Survey.
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A review of evaluations of all female sexual assault victims (892) presenting to an urban
hospital emergency room over a 34-month period found that general body injury was
found in 52% of the patients, but serious injury requiring emergency medical
intervention was uncommon. 20% of those examined had genital or anal injury. 15%
had bruises or abrasions of the vulvar or perineal tissues. 7% had lacerations of those
areas. Genital or anal injury was more than twice as likely in women older than 49
years of age.31
29.3% of women with a history of sexual assault reported at least six somatic
symptoms, compared with 15.8% of other women.32
Gastrointestinal (GI) problems may be second only to depression as the most frequent
long-term result of child sexual abuse.33
As many as 71% of female children and adolescents who experience forced sex with
an adult for more than two years may later develop GI disorders.34 A common
complaint is irritable bowel syndrome (IBS), a chronic condition that involves cramping
and constipation alternating with diarrhea. Chronic abdominal pain is another frequent
symptom. Almost 1/3 of the women with either of these complaints had been victims of
rape or incest.35
Child sexual assault survivors are: 36
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2½ times as likely to have pelvic pain and pelvic inflammatory disorder, breast
diseases ranging from fibrocystic changes to cancer, and yeast infections;
1½ times more bladder infections;
More likely to have complications of pregnancy and to have chronic pain,
including backaches and headaches. The more serious the abuse, the more
serious the resulting medical problems.
IMPACT ON MALE VICTIMS
Male sexual abuse victims, compared with other males, are: 37
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Four times more likely to suffer major depression;
Three times more likely to have bulimia;
31
Sugar, N.F., D.N. Fine, and T. Eckert. Physical Injury After Sexual Assault: Findings of a Large Case Series.
190(1) American Journal of Obstetrics and Gynecology (2004): 71-76.
32 Golding, Jacqueline. Sexual Assault History and Physical Health in Randomly Selected Los Angeles Women.
13(2) Health Psychology (1994): 130-138.
33 Drossman, D.A., et al. Sexual and Physical Abuse and Gastrointestinal Illness: Review and Recommendations.
123(10) Annals of Internal Medicine (Nov. 15, 1995): 782-794.
34
Study by Rimsza, et al, cited in Drossman, et al, 1995.
35 Drossman, et al, 1995.
36 Forrest, M.S., The Relationship of Child Sexual Abuse to Medical Problems in Adulthood. The Healing Woman
(Jan. 1994).
37 Holmes, W. C., M.D., MSCE, and G.B. Slap, M.S., M.S. Sexual Abuse of Boys. 280(1) Journal of the American
Medical Association (1998): 1855-1862.
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Twice as likely to develop an antisocial personality disorder;
Twice as likely to have behavioral problems;
Twice as likely to suffer from low self-esteem;
Twice as likely to run away from home;
Twice as likely to have legal problems.
Sexually abused boys report more high-risk sexual behavior, including the use of
prostitutes; unprotected anal intercourse; a higher number of sexual partners; a lower
rate of condom use; higher rates of sexually transmitted diseases and higher rates of
partner pregnancy.38
Sexually abused boys were more than four times as likely to have forced sexual contact
with another person, most often another boy (frequently a younger brother). 39
PREGNANCY
Fear of pregnancy is one of the most common fears of both women and adolescent
girls following sexual assault. 34% of rape victims in the National Victim Center survey
feared becoming pregnant.40
For 60% of “sexually active” girls under 14, their only sexual activity had been as victims
of rape.41
62% of pregnant and parenting adolescent girls were found to have experienced
molestation, attempted rape or rape before their first pregnancy; from one-third to onehalf were repeatedly sexually assaulted.42
Between 11% and 20% of pregnant teenagers in a large study became pregnant as a
direct result of rape.43
75% of children born to high school girls are fathered by men older than high school
age, most of whom are over age 20; high school boys account for only 25% of births to
all school age girls.44
38
Holmes, W. C., M.D., MSCE, and G.B. Slap, M.S. Sexual Abuse of Boys. 280(1) Journal of the American Medical
Association (1998): 1855-1862, citing numerous studies.
39 Ibid.
40 Kilpatrick D.G., C.N. Edmunds, and A. Seymour. 1992. Rape in America: A Report to the Nation. Arlington, VA:
National Victim Center.
41 Adolescent Pregnancy Prevention Coalition of North Carolina. 1994. Adult Males + Teen Girls = Teen
Pregnancies.
42 Boyer, Debra, and David Fine. Sexual Abuse as a Factor in Adolescent Pregnancy and Child Maltreatment. 24(1)
Family Planning Perspectives (Jan. 1992).
43 Ibid.
44 Males, Mike. Schools, Society and ‘Teen’ Pregnancy. Phi Delta Kappan (March 1993), cited in the ICASA Coalition
Commentary (Spring 1995).
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SPECIAL ISSUES
ABORTION
About 14,000 women annually have abortions following rape or incest. 45
87% of all U.S. counties lacked an abortion provider in 2000.46
SEXUAL ASSAULT AND AIDS
In a study, 73% of the women surveyed reported that they were “extremely fearful” or
“concerned” about contracting HIV as the result of a rape. Women who were raped by
a stranger were significantly more likely to express fear or concern about HIV exposure
than women who were raped by partners or acquaintances. More than 80% of the
women surveyed indicated that they wanted more HIV/AIDS-related information during
post-assault medical care.47
Victims of sexual assault who are penetrated orally, vaginally, or anally are at risk of
contracting the HIV virus that leads to AIDS. It is impossible to calculate how many
victims have become HIV infected due to sexual assault.
Sexual assault victims should be informed of the possibility of HIV infection. Many will
be concerned about the risk of contracting the virus. It is important for medical
professionals, counselors and others who work with victims to have accurate and
current information about HIV, HIV testing and AIDS.
Survivors of child sexual abuse often engage in behaviors, such as substance abuse,
prostitution, and having multiple sex partners, that increase risk of exposure to HIV.
Male survivors are twice as likely to contract HIV. Female survivors are four times as
likely than non-survivors to have been prostituted; male survivors are eight times as
likely. Survivors are 40% more likely to have sex with someone they didn't know. 48
TESTING SEX OFFENDERS FOR AIDS
After a preliminary hearing or indictment, a sexual assault victim in Illinois can ask the
state's attorney to request the court to order the defendant to be tested for the HIV
virus. The test results are delivered to the victim and the judge in a sealed envelope.
The costs of the test are paid by the county. The Illinois Supreme Court has upheld the
constitutionality of post-conviction HIV testing of sex offenders.
SEXUAL ASSAULT SURVIVORS EMERGENCY TREATMENT ACT
45
Alan Guttmacher Institute. 2006. Facts in Brief: Induced Abortion in the United States. www.agi-usa.org.
Alan Guttmacher Institute. 2006. Facts in Brief: Induced Abortion in the United States. www.agi-usa.org.
47 H. Resnick, et al. Rape-related HIV Risk Concerns Among Recent Rape Victims. 17(7) Journal of Interpersonal
Violence. (2002): 746-759.
48 S. Zieler, et al. Adult Survivors of Childhood Sexual Abuse and Subsequent Risk of HIV Infection. 8(5) American
Journal of Public Health (May 1991), cited in the ICASA Coalition Commentary (Fall 1996).
46
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The Sexual Assault Survivors Emergency Treatment Act (SASETA) governs medical
care and forensic evidence collection for sexual assault victims. SASETA provides:
Minimum healthcare standards for hospitals providing medical care to sexual assault
victims, including:
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treatment for injuries;
treatment for sexually transmitted infections, including HIV;
information about emergency contraception and where it is available;
a referral for counseling.
Collection of forensic evidence through the use of the Illinois State Police Sexual
Assault Evidence Collection Kit.
Payment for emergency room and ambulance services if the victim is not a public
aid recipient and does not have private insurance.
Minors are permitted to consent to their own health care without parental consent under
SASETA.
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