Why the First Three Months Are Critical for Sexual Assault Survivors With PTSD

Sexual assault is a tragically common occurrence, one that leaves survivors with an incredible mental and physical burden. To highlight some startling statistics: Every 68 seconds a person is sexually assaulted in the United States alone. More than one in three women and nearly one in four men have experienced sexual violence involving physical contact at some point. In addition, the 2015 U.S. Transgender Survey Report found that 47% of participants had been sexually assaulted in their lifetime. Not only are these instances vile in the moment, but they can create ongoing mental health issues for survivors.

A recent study from Trauma, Violence, & Abuse looked at the frequency of post-traumatic stress disorder (PTSD) following sexual assault using a sample of 2,106 survivors. One month out from a sexual assault, 75% of people met the criteria for a PTSD diagnosis. The number dropped to 54% after three months and to 41% after one year. Symptom recovery was quicker in the first three months and then slowed as time went on.

Sexual assault is an undeserved, painful event and can produce lasting trauma, as the study showed. According to Elizabeth L. Jeglic, PhD, a psychology professor at John Jay College of Criminal Justice at The City University of New York and coeditor of “Sexual Violence: Evidence Based Policy and Prevention,” it impacts the neural, endocrine, and immune system. Following the assault, the body enters fight or flight mode and releases the stress hormone cortisol.

“[This] response that helps us deal with a traumatic event in the moment stays switched on long-term instead of going back to baseline,” adds Aimee Daramus, PsyD, author of “Understanding Bipolar Disorder.” She explains that this can lead people to develop amnesia around a traumatic event or have intrusive thoughts and flashbacks.

How PTSD Can Manifest

The common nature of PTSD post-sexual assault doesn’t ease the disorder’s pain and discomfort. “Trauma can change the way we see the world, and if we get stuck in a very negative mindset, this can severely impact our quality of life,” says Ruth L. Varkovitzky, PhD, a clinical psychologist specializing in treating PTSD across the lifespan and owner of Renewal Psychology. “Experiencing a trauma can lead to a cycle of avoidance—avoiding people, places, memories, and feelings—such that our world gets smaller and smaller. We can feel trapped, like there’s no way out.” 

PTSD will not manifest at the same time or in the same way for everyone, but there are certain signs of it to look out for. According to Lena Queen, LCSW, MEd, a clinical somatic sexologist and owner of Journey Wellness and Consulting Group, symptoms of PTSD from sexual assault can include: 

• Difficulty trusting themselves or others
• A lack of self-compassion or compassion for others 
• Internalized shame or guilt
• Self-harm, suicidal ideation, or attempt 
• Flashbacks of the assault 
• Hypersensitivity to perceived danger 
• Memory loss
• Low energy
• Anxiety or depression
• Inability to be intimate with others 
• Unable to experience joy and pleasure, sexual and non-sexual
• Difficult relationship with touch
• Struggling sexuality and gender 
• Body image issues such as body dysmorphia 
• Inability to set boundaries

Sexual assault can affect a person’s sense of identity, leaving them feeling like an almost different person than before it happened. “Sexual assault is different from other forms of PTSD, where victims do not usually experience the same disbelief and blame,” says Daramus.

A survivor’s chance of PTSD increases if they face doubt about what happened or a lack of support from others, adds Jeglic.

Treatment for PTSD

Yes, the study found that natural recovery may occur at a quicker rate in the first three months after a sexual assault. However, everyone is not ready to confront or aware that they are experiencing PTSD immediately after an assault. Also, some people may not come to terms with the fact that they were assaulted for quite some time.

No matter when you seek help, it is always possible to work through symptoms of PTSD—the process may just take longer. According to Jeglic, this may be in part due to negative thoughts and avoidance becoming more ingrained. 

There are many options for treatment whenever a person is ready. “We know that our gold-standard treatments for PTSD can be useful whether someone has recently been assaulted, or has been waiting for the right time to engage their recovery process,” says Varkovitzky. If mental health services are available to you, she recommends seeking out experts in cognitive processing therapy or prolonged exposure—both fall under the umbrella of cognitive-behavioral therapy.

Cognitive Processing Therapy (CPE). This form of cognitive behavioral therapy helps individuals challenge negative beliefs and automatic thoughts brought on by trauma that perpetuate PTSD. Patients also dive into the assault and their perception of it.

Prolonged Exposure (PE). This technique helps individuals face trauma-related memories and triggers instead of continual avoidance. Exposure may occur during sessions or through outside assignments. 

Eye Movement Desensitization and Reprocessing (EMDR). This is another technique to pursue in therapy. It can help people process thoughts and memories associated with trauma. 

“Treatment for survivors of sexual trauma should be client-centered, intersectional, harm-reductive, sex-positive, healing-centered, and accessible,” says Queen. In addition to the previously mentioned therapy practices, Queen recommends options such as hypnotherapy, somatic sex therapy, pelvic floor therapy, and massage therapy. Non-clinical techniques to help with PTSD from sexual assault include breathwork, sex coaching, cannabis, and yoga, she adds. 

“Some people can recover from trauma without professional support, and others may need some structure and guidance. Connecting with a trusted person to ask for help is always a good step. There are many licensed health professionals who have extensive training in supporting survivors in their healing process,” adds Varkovitzky. 

Resources for PTSD

Whether you’re unsure if you’re experiencing PTSD, want to learn more about treatment options, or are looking for advice on how to support a loved one, there are many free resources available to help. Here are some of the options out there. 

RAINN (the Rape, Abuse, and Incest National Network): Along with detailed information online, their national sexual assault hotline is confidential and available 24/7 at 800-656-HOPE or through an online chat service. 

American Psychological Association. Information about PTSD and treatment. 

National Center for PTSD. Information about PTSD and treatment. 

Leda Health. Support groups created by survivors. 

The Trevor Project. Crisis intervention and suicide prevention services for LGBTQ+ individuals. A confidential hotline is available 24/7 at 866-488-7386 or through an online chat service. 

YWCA Sexual Assault Response Center. A free and confidential rape crisis service for sexual assault survivors aged 12 and older in Delaware. A confidential hotline is available 24/7 at 800-773-8570. 

The National Queer and Trans Therapists of Color Network. A database of queer and trans therapists of color to use when seeking a mental health professional.