A reliable roadmap for healing from sexual assault and sexual trauma

Your abuser does not get to define the rest of your life. You can know this intellectually, but it’s a whole different beast to know it in your body. People who experience sexual assault might internalize their fear and trauma so they continue to feel unsafe in their skin. They might grapple with flashbacks and nightmares. They might avoid triggering places or situations, or have difficulty trusting others. It’s brutally unfair that the minds and bodies of sexual assault victims are made to suffer when THEY’VE DONE NOTHING WRONG. The burden should be on the perpetrators, not the survivors.

But we live in this world, so it’s up to you. How can you take back your control and sense of security after an assault? There are countless paths forward that can help you reclaim your life. Mental health experts and victim advocates have devoted decades to researching the most effective ways of helping people recover from sexual trauma. And they have solid answers: evidence-based, empathetic, trauma-informed approaches that can be tailored to each individual at the moment they most critically need support. 

This article will proceed in stages, covering 1) What to do in the immediate aftermath of a sexual assault to ensure your safety and pave the way for future recovery; 2) What sexual trauma symptoms look like; 3) Why avoidance is the worst possible course of action; 4) The best psychosocial treatments for sexual trauma; 5) The power of trauma narratives; 6) What can help if you’re struggling with sexual intimacy after an assault; and lastly, for those who want to support victims, 7) How to help loved ones heal from sexual trauma. Let’s get started.

Trigger warning: This content below might be triggering or traumatizing to survivors of sexual assault, sexual abuse, or other forms of violence. It might also be disturbing or upsetting to some readers. 

How to Recover from Sexual Assault: First Things First

Before you can begin rewiring your brain after a trauma, you need to ensure your own safety. You can’t start your healing process if you’re still in harm’s way. After there’s distance between you and your attacker, call a trusted friend or a sexual assault hotline (see resources section at the bottom of this article). Then seek medical care. The Centers for Disease Control and Prevention (CDC) website offers guidelines for reducing your risk of an unwanted pregnancy or a sexually transmitted infection (STI). 

Even if you’re not sure if you’re going to file criminal charges against your attacker, there might be evidence on your body that could prevent future violent crimes. Preserve any physical evidence in a paper bag, not a plastic bag. You have about 72 hours to get a free sexual assault forensic exam (a rape kit) before DNA evidence starts to degrade. Plus, every hour makes it harder to resist taking a shower, going to the bathroom, changing clothes, or otherwise disturbing evidence (aka living your life). The sooner you can stop thinking of your body as a crime scene, the better. 

The forensic exam might sound scary to someone who’s already been physically traumatized, but it will be performed by a specially trained nurse examiner, and you can have someone with you for support. And unless you’re underage, the evidence isn’t actionable until you say it is. 

If you know the person who sexually assaulted you (as 80% of victims do), and you need to make a safety plan, do it now. Once you are safe, try to return to a basic self-care routine as soon as you can. This means nutritious food, hydration, fresh air, exercise, a warm bath, the company of friends… whatever you can manage. A self-compassionate routine will serve as the best foundation for your emotional recovery.

Sexual Trauma Symptoms and PTSD

Not everyone who experiences a sexual trauma develops post-traumatic stress disorder (PTSD), but according to a study published in 2021, in the week following a sexual assault, 81% of people have symptoms of PTSD. In the month after a sexual assault, 75% of survivors meet the DSM-5 criteria for a diagnosis of PTSD. After three months, it’s 54% of survivors, and after a year, it’s 41% of survivors. Emily Dworkin, PhD, a co-author of that 2021 study, has shown that depressive disorders are more common in survivors of sexual assault. Sexual violence can also be hugely relevant to other mental health problems like substance abuse and suicidality. 

Symptoms of PTSD from sexual assault overlap with symptoms of “rape trauma syndrome” (RTS), though experts rarely use the latter terminology. PTSD symptoms include the following:  

• Intrusive thoughts
• Flashbacks
• Nightmares
• Trouble concentrating
• Social withdrawal
• Emotional avoidance
• Depression and anxiety
• Self-blame and guilt
• Self-doubt
• Self-harming behaviors and/or suicidal ideation
• Memory loss or fragmented memory
• Somatic symptoms like body aches and increased pain
• Hypersensitivity to perceived threats (chronic hyperarousal or hypervigilance) indicating changes in brain circuitry involved in the stress response

In addition, those with complex PTSD, also known as complex trauma disorder, may experience extreme emotional dysregulation and distortion of identity, usually due to chronic trauma. 

Why Avoidance Is the Wrong Approach

Though the therapeutic recovery process may happen faster if undertaken within the first three months after a sexual assault, it’s never too late to seek professional support for symptoms of PTSD. Trauma doesn’t go away if it’s ignored. Instead, unaddressed trauma tends to fester, reinforcing avoidance behaviors and negative beliefs about oneself. Some people choose to process their experience on their own, without seeing a therapist, and that’s okay. But humans just aren’t very good at recognizing all the hoops they jump through to avoid pain. Those insights tend to come from the outside.   

Let’s say that therapy doesn’t appeal to you because you don’t want to relive your trauma. You’d rather just put it behind you. You’re fine. You’re moving on. And yet, you feel diminished somehow. You don’t have the confidence that you used to. You don’t enjoy all the things that used to make you happy. But eventually the trauma will run its course and you’ll feel like yourself again, right? It’s entirely possible. But it’s also possible that your negative beliefs will become more and more embedded in your psyche. That you’ll start drinking a little more every night. That you won’t be able to trust a future partner, or enjoy a healthy sex life. By not facing your feelings and your memories, you run the risk of never regaining control. Instead of you being in the driver’s seat, it will be the scared kid who desperately needs to avoid further pain. All the psychological research on sexual trauma shows that the only way out is through. And the best way to get through is in the company of someone you trust, who knows what they’re doing. Even though it will always be you behind the wheel.      

Best Treatments for Sexual Trauma

The first thing you will do with a therapist is establish trust and safety. That will lay the groundwork for everything moving forward. If you don’t feel comfortable with your therapist, find another one. Seriously. You need to feel accepted and supported from the get-go. 

A therapy session will probably begin with a psychosocial assessment and/or trauma screening. You don’t have to get into the details of what happened at this early stage, but your therapist may want to get a sense of how you’re currently coping, if you have any history of mental health conditions, if you have friends or a partner whom you can lean on from day to day. Through these conversations, a compassionate therapist will listen closely in order to validate you and determine what types of intervention will be most effective. They will gain a sense of your strengths and your readiness for therapy. 

In subsequent stages of the recovery process, a therapist may utilize one of the following evidence-based approaches, or a hybrid intervention, depending on your feedback. Many of these methods aim to undo the neurobiological effects of trauma. When someone experiences a traumatic event, their normal coping mechanisms are overwhelmed and their brains are flooded with epinephrine (adrenaline), cortisol, and other stress-related hormones that might be necessary for the body’s survival. These fight/flight/freeze hormones disrupt parts of the brain that deal with emotional processing and memory. So a big part of trauma therapy is accessing those traumatic memories, reprocessing them, and storing them properly. Many of the following interventions can be channels for this kind of healing.  

• Cognitive processing therapy (CPT). CPT is a form of trauma-focused cognitive behavioral therapy (TF-CBT), a modality that hinges on trauma narratives (more on those below). CPT was developed specifically as a way to treat rape victims. It’s highly effective at reducing the symptoms of PTSD and depression.
• Prolonged exposure therapy (PE). Also called “flooding,” PE is another TF-CBT approach. It might use in vivo (direct) or imaginal exposure to help people with PTSD symptoms. Research shows that PE is more effective than supportive counseling in treating PTSD related to sexual abuse.
• Eye movement desensitization and reprocessing therapy (EMDR). EMDR uses bilateral stimulation, usually in the form of eye movements, to reduce emotional distress affiliated with trauma.
• Psychodynamic psychotherapy. This approach is a deep, long-term process of self-reflection and self-examination derived from the theories of Sigmund Freud.
• Rational emotive behavior therapy (REBT). Research shows that REBT can effectively treat trauma symptoms like depression, guilt, and low self-esteem in adult victims of childhood sexual abuse.
• Narrative exposure therapy (NET). NET is a short-term intervention that’s often used to treat complex trauma in refugee populations.  
• Multiple channel exposure therapy (MCET). MCET is an approach developed to help people with PTSD who also experience panic attacks. 
• Stress inoculation training (SIT). SIT is a type of cognitive behavioral therapy (CBT) that can help people recognize trauma triggers and build coping skills.
• Mindfulness training. Mindfulness interventions can help people address the fear and anxiety associated with trauma by keeping them in the here and now, not the imagined future.
• Support groups and group therapy. Group sessions can be a helpful supplement to individual therapy sessions, though research shows that they can extend overall treatment time if initiated before personalized, one-on-one sessions.

How long will you have to be in therapy to get the tools you need to heal from sexual assault? It depends on the individual and the extent of their trauma, but the TF-CBT approaches to treating PTSD tend to require only 10-12 sessions, at a pace of one session per week. 

What Is a Trauma Narrative?

A trauma narrative is your own story, retold. Research shows that by retelling the story of your trauma in your own words, you reduce your emotional distress. Trauma disrupts the normal functions of memory and emotion, so a traumatized person will highlight negative information as their brain tries to keep them safe from threats. But a trauma narrative can help put that information into context. That’s why it’s critical to many forms of PTSD therapy. Telling your story works because it desensitizes you to your emotional triggers, it gives you a more meaningful perspective on the trauma, and it puts you back in control of your life narrative.

But just because trauma narratives can help in recovery, that doesn’t mean you have to share them with the world. You don’t owe anyone else your story. You may feel empowered by hearing other survivors’ stories of resilience, however, and potentially want to take part in these conversations one day. Numerous celebrities have spoken out about being sexually assaulted or sexually abused, including Lady Gaga, Oprah Winfrey, Gabrielle Union-Wade, Jessica Simpson, Viola Davis. Queen Latifah, Tyler Perry, and Ozzy Osbourne. You can also find dozens of survivor stories on the RAINN website, or read novels and other books that might inspire hope and healing. 

Sexual Healing After Trauma

People who experience sexual assault may have problems transitioning back to consensual, pleasurable sex. They might feel physically numb due to their PTSD. Some victims feel detached or disconnected from their own bodies, which obviously affects healthy intimacy. They may not want to be touched due to their startle response. Or they might become hypersexual in response to their trauma. Trauma-informed, body-based practices like the following can help reconnect trauma victims to their physical sensations:

• Yoga, Tai Chi, and Qigong
• Massage
• Embodied-relational therapy (ERT)
• Mindfulness meditation
• Somatic experiencing
• Sex therapy
• Gestalt-based interventions
• Rhythmic movement

Boundary issues and trust issues are also common in the wake of sexual assault. Assault, especially from someone you know in the form of intimate partner violence (IPV), is a massive betrayal and violation. So reestablishing healthy relationships and healthy sexual functioning can take time. Your romantic partner needs to empower you to proceed at your own pace. 

How to Help Loved Ones Heal from Sexual Trauma

If your loved one has been sexually assaulted, you may feel powerless to alleviate their pain. But you can still be a vital part of their recovery. You can bear witness to their suffering. You can give them options. You can listen to their story. You can believe them. You can reassure them that it wasn’t their fault. You can help guide them to the professional resources they may need to heal. If someone tells you about their sexual assault and you don’t know how to respond, RAINN recommends the TALK method:

T – Thank them for telling you. This shows that you appreciate their trust, and your gratitude can help put them at ease.

A – Ask how you can help. This is not the time to offer advice, tell them what they should do, or reprimand them for not going to the police. This is the time to help empower your loved one to make their own decisions.

L – Listen without judgment. Don’t interrupt them, compare your own experience, or try to minimize what they suffered.

K – Keep supporting. This means checking in, offering normalcy, and being patient throughout their recovery. 

24/7 Sexual Assault Resources

If you’re in a crisis, reach out immediately to any of the organizations below. Many of them have texting or online chat services as well if you can’t make a phone call. 

• Rape, Abuse & Incest National Network (RAIN) National Sexual Assault Hotline, 1-800-656-HOPE (4673)
• Sexual Assault Center Crisis and Support Line, 1-866-811-RISE (7474)
• The Trevor Project crisis intervention and suicide prevention hotline for LGBTQ+ individuals, 1-866-488-7386 
• National Suicide Prevention Lifeline, 1-800-273-8255

Disclaimer: The information on this page is not intended to replace assistance, diagnosis, or treatment from a clinical or medical professional. Readers are urged to seek professional help if they are struggling with a mental health condition or another health concern.