Emily R. Dworkin, a senior fellow at the University of Washington School of Medicine in Seattle, studies how the social interactions of trauma survivors can affect their recovery. She was also the lead author of a paper published in the journal Clinical Psychology Review in 2017 that looked through more than 100,000 studies conducted in the last 50 years and found nearly 200 relevant ones on the relationship between sexual assault and mental health to analyze.
What she found, Dworkin says, is strong evidence that sexual assault is associated with an increased risk for multiple forms of psychological harm “across most populations, assault types and methodological differences in studies.” Too many survivors still face stigma and internalize that blame, and that can make it harder to seek help. And while some types of therapy have been shown to be helpful, she says, more information on evidence-based treatments for survivors “is critically needed.”
Dworkin talked with NPR about her research findings and offered her perspective on where society and science need to go next to prevent assaults and help survivors heal.
NPR: You looked at a lot of studies about the mental health impact of sexual assault, but it’s not an area as well-studied as say, heart disease. So what do we know?
Dworkin: Sexual assault [any type of sexual activity or contact that happens without the consent of both people] began getting research attention in the ’70s as society as a whole was going through a feminist awakening, and it kind of developed at the same time as PTSD [post-traumatic stress disorder], which was then known as “combat trauma.” Many things can lead to depression or anxiety. People with PTSD relive the trauma in the form of intrusive memories, nightmares, or even flashbacks. They avoid things that remind them of the trauma.
The symptoms that people were showing when they were coming home from war were the same as victims of rape trauma — recurring memories and a wish to avoid triggering them.
These days, lots of people are doing research, but there’s still a lot left to understand. What we do know is that sexual assault is associated with a higher risk for a lot of different mental health problems, including PTSD [and depression, anxiety, substance abuse and suicidality] … especially PTSD.
NPR: What do we know about how ethnicity and education affects the mental health of survivors of sexual assault?
Dworkin: We need to know more. Some of my past research on queer women shows that ongoing forms of stress can compound stress. And we know that people from marginalized groups are just at greater risk for sexual assault [and a number of other health problems]. So it’s likely that these groups experience more trauma — but I don’t think we can completely say for sure.
NPR: How does sexual assault compare with other forms of trauma, in terms of effects on mental health?
Dworkin: We never want to have the Olympics of trauma. But compared to other types of life-threatening trauma, survivors of sexual assault do seem to be more likely to get PTSD. In my preliminary look at the data from 39 studies on this topic, it seems like 36 percent of survivors meet criteria for a diagnosis of PTSD in their lifetime, versus 12 percent of people who don’t have a history of sexual assault.
My thinking is that sexual assault is a unique form of trauma. It is highly stigmatized, and when people go to seek help for it, unlike in a car accident — well, the police are not going to ask you if you’ve really been in a car accident.
NPR: What are the resources and treatments that work best for survivors who are experiencing PTSD or other mental health symptoms?
Dworkin: First-line options should be things that we know work well. What I recommend is prolonged exposure therapy [helping people gradually approach trauma-related memories and feelings] or cognitive processing therapy [a specific type of cognitive behavioral therapy that helps patients learn how to challenge and modify unhelpful beliefs related to the trauma]. Both have been around since the ’80s and were developed to treat survivors of rape. They have really strong evidence of reducing symptoms or eliminating the diagnosis [of a mental health disorder].
For resources, look for a good therapist who offers cognitive processing therapy. Also, you can check out the Association for Behavioral and Cognitive Therapies [for more information about the treatment].
Read more on NPR.org.