Sexual Assault and Health: Trauma-Related Appraisals and Physical Health

Note: The following post, written by Dr. Kerry Gagnon (Ph.D. ’18), describes findings from her dissertation research. 

An estimated one in six women in America has been sexual assaulted[1]. In addition to the psychological costs of sexual assault, many survivors face physical health consequences that can last for weeks up to years. Physical health symptoms can include gynecological problems, gastrointestinal problems, chronic pain, headaches, high blood pressure to name a few; all of which can cause substantial distress and impairment in survivors’ day-to-day lives.

Survivors also vary a great deal in whether they have physical health problems as well as the kinds of physical health problems they experience. Because understanding the variables that affect health trajectories is imperative for providing effective services and treatment to survivors, we sought to identify factors that contribute to negative physical health trajectories following sexual assault.

We turned first to considering women’s perceptions of the sexual assault, because research has shown us that the way we think influences our health, and our health influences the way we think. We wanted to ask if the ways that women perceive the sexual assaults – with more fear or anger, for example – could change their physical health. Or, could a women’s physical health following sexual assault influence subsequent perceptions of the assault?

To address these questions, we drew on information gathered from women who were sexually assaulted in the last year in a study that was a collaboration with Denver’s Sexual Assault Interagency Council. We focused on information from 156 women whom we interviewed at three different time points across six months. To be interviewed, women had to have disclosed the sexual assault to a service provider (e.g., police, counselor, medical provider). At each interview, we asked women about their perceptions of the sexual assault – such as feelings and thoughts of alienation, anger, betrayal, fear, self-blame, shame – and physical health problems. Women interviewed for this study were socially and ethnically diverse, ranging in age from 18-62.

Women described a wide-range of physical health problems across the six-month time period. On average, women reported experiencing seven different physical health problems. Headaches were the most commonly endorsed physical health problem. Women also commonly reported having cold/flu, sore throat, diarrhea, abdominal pain, and allergies. The breadth of physical health problems endorsed by women highlights the importance of assessing for a large range of physical health concerns, ranging from minor symptoms and complaints to more severe health problems, following sexual assault.

We also discovered that physical health problems changed how women perceived their sexual assaults. Experiencing physical health problems caused women to feel greater anger and alienation (e.g., feeling lonely and isolated) three months later. This makes sense given that experiencing physical health problems after a sexual assault may reinforce the unfairness of the assault and its consequences and cause women to feel greater anger. Experiencing physical health problems following an assault, and potentially not getting the support and care they need, may cause women to feel isolated and alone. These findings highlight the importance of assessing for and treating physical health concerns following sexual assault, as alleviation of physical health problems can help to alter women’s perceptions of their assault and potentially reduce the likelihood of experiencing longer-term health concerns.

The current study leads the field in examining the interplay between physical health and perceptions of sexual assault. From this study, we learned that women experience a broad range of physical health problems following sexual assault and that these physical health problems impact the ways in which women perceive their sexual assault experiences. The findings from the current study, in conjunction with research on trauma-related health consequences, support an integrative framework in which biological, psychological, and social factors are considered when understanding health outcomes of sexual assault.

…women experience a broad range of physical health problems following sexual assault and that these physical health problems impact the ways in which women perceive their sexual assault experiences.

We also identified new questions that need to be addressed. Using an integrative approach, there may be factors that should be considered when understanding physical health outcomes of sexual assault. For example, trauma-related characteristics (e.g., relationship to the offender; type of sexual assault), psychological health (e.g., PTSD, depression, substance use), and social factors (e.g., social support; health-seeking behaviors) may impact women’s physical health and perceptions of sexual assault. The current study was also limited by the physical health information that was available (e.g., only having information about women’s physical health after the sexual assault). Future research examining physical health over time, including before and after sexual assault, would assist in our understanding of the development and trajectory of physical health problems following sexual assault. As we expand our knowledge of the impact of sexual assault on survivors’ health and well-being, we can further enhance our ability to treat and serve survivors of sexual assault.

This research was funded by the National Institute of Justice [Grant #2012-W9-BX-049]. The views expressed are those of the authors and do not necessarily represent the views or the official position of the National Institute of Justice or any other organization.

Thank you to our community partners who made this research possible, particularly Denver’s Sexual Assault Interagency Council.

1. National Institute of Justice & Centers for Disease Control & Prevention, Prevalence, Incidence and Consequences of Violence Against Women Survey (1998).