Sexual assault, sexual abuse, and harassment: Understanding the mental health impact and providing care for survivors: An International Society for Traumatic Stress Studies Briefing Paper

Recent events including revelations of the systematic cover-up of widespread childhood sexual abuse in the Catholic Church, sexual assault and harassment accusations involving many prominent individuals in the entertainment and other industries in the U.S., Canada, Europe, Australia, and Japan, global coverage of cases of violent rape and rape-murder of girls and young women in India, and the #metoo movement, have served to increase public consciousness internationally regarding the pervasiveness of various forms of sexual victimization worldwide. In response, the International Society for Traumatic Stress Studies (ISTSS) commissioned this briefing paper to inform its membership, policymakers, and global stakeholders about the prevalence, impact, and barriers faced by survivors of various forms of sexual victimization including attempted and completed rape, sexual abuse in childhood, and sexual harassment in workplace and educational settings. This paper outlines the research evidence regarding (1) the prevalence of different forms of sexual victimization worldwide including childhood sexual abuse, various forms of sexual assault in adulthood, and sexual harassment in workplace and educational settings, (2) the prevalence of various forms of sexual victimization among several marginalized groups, (3) the psychological, behavioral, and physical health impacts of sexual victimization in childhood and adulthood, (4) evidence-based interventions for survivors of sexual victimization, and (5) barriers to treatment seeking commonly faced by survivors of different forms of sexual victimization. Recommendations are also made in the areas of policy, practice, research, and for professional organizations. Research conducted throughout the world continues to document the alarmingly high prevalence of various forms of sexual victimization throughout the lifespan, including the sexual abuse of children, sexual assault of adults, and sexual harassment within individuals’ place of employment and in educational settings. Although all individuals are vulnerable to experiences of sexual victimization, sexual assault, abuse, and harassment are gendered crimes, such that women and girls are more likely to be victims of these forms of sexual violence. In addition, members of a number of marginalized groups face substantially increased vulnerability to sexual victimization. These include individuals with disabilities, sexual and gender minorities, homeless individuals, individuals engaging in various kinds of sex work, and members of indigenous populations. Further, the impact of sexual victimization is both broad and targeted, with various forms of sexual victimization, including experiences of childhood sexual abuse and sexual assault in adulthood, associated with a host of negative outcomes including the development of posttraumatic stress disorder, depression, anxiety, substance use disorders, eating disordered pathology, suicidality, dissociation, and high risk sexual behaviors. Further, sexual victimization is associated with risk for a number of negative physical health outcomes including obesity, gastrointestinal disorders, chronic pelvic pain, and reproductive health issues. There exists a robust evidence base supporting the efficacy of psychological treatment for PTSD symptomology among adult survivors of childhood sexual abuse and sexual assault. Of extant treatments, cognitive-behavioral based treatments have the strongest evidence for their efficacy. Similarly, cognitive-behavioral treatments, such as trauma-focused CBT, have demonstrated efficacy in treating PTSD and depressive symptomology among children and adolescents who have experienced sexual abuse. There is also some evidence supporting the efficacy of psychopharmacological treatment in reducing PTSD symptomology among adult survivors of sexual abuse or assault. Conversely, there is far more limited research examining the efficacy of psychological treatments for PTSD in other cultural contexts, with the vast majority of research involving United States samples. There is also much less evidence regarding the impact of trauma-focused treatments on other outcomes besides PTSD symptomology and depression, or examining how to treat additional behavioral and mental health issues among survivors of sexual victimization. Finally, almost no research has evaluated the efficacy of psychological treatments for individuals who have experienced sexual harassment in their workplace. Further, research documents that survivors of various forms of sexual victimization often face substantial barriers to disclosing their experience or seeking formal help. These barriers include issues related to defining the experience as a victimization, concerns about not being believed or taken seriously, and feelings of stigma, shame, or embarrassment. Other barriers include concerns about whether the experience will be reported to authorities, mistrust of formal support systems, and prior negative experiences following disclosure of a sexual victimization experience. Many survivors also may be unaware of services that are available to them, may believe that available services are not appropriate for them, and may also face substantial barriers to accessing the care that is available, and available care may be inadequate for addressing their needs in many parts of the world. Finally, it is important to note that many individuals who experience sexual victimization face ongoing issues related to poverty, socioeconomic disadvantage, ongoing personal and community violence, and belong to marginalized groups. Given the prevalence, impact, and substantial barriers to care faced by individuals who experience sexual victimization, including childhood sexual abuse, sexual assault, and sexual harassment, it is clear that concerted, international, and collaborative efforts involving policymakers, researchers, clinicians, professional organizations, and other global stakeholders is imperative.

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