All the Ways Sexual Assault and Harassment Can Affect Your Physical and Mental Health

When Christine Blasey Ford came forward in September to accuse Supreme Court nominee Brett Kavanaugh of sexual assault—more than 30 years ago when they were both in high school—she made it clear that the alleged encounter had haunted her for decades.

Ford says that, when the two were both teenagers at a house party, an intoxicated Kavanaugh pushed her into a bedroom, held his hand over her mouth to muffle her screams, and tried to take her clothes off. She says she was able to escape and never told anyone about the incident until 2012 until it came up in couples’ counseling with her husband. (Kavanaugh denies committing any behavior of the sort.)

Ford told the Washington Post that, after the incident, she thought she was fine. “This is nothing, it didn’t happen, and he didn’t rape me,” she recalled telling herself. But years later, she says, she realized that the incident “derailed” her substantially “for four or five years.” She struggled academically and socially, experienced anxiety and post-traumatic stress disorder, and was “very ill-equipped” to have healthy relationships with men.

It’s not clear how Ford’s allegations will ultimately affect Kavanaugh’s nomination. But regardless, her story has brought to light an important issue about sexual assault and harassment–and has been the topic of much debate in the media and among the general public.

Depending on who you ask, what Ford has described sounds like everything from attempted rape to “rough horseplay” among teenagers. The event—if it did happen—lasted only a few minutes, and no clothing was removed. Plus, it was decades ago, some have pointed out, so Ford’s memory may not be accurate. And could an event like this really traumatize someone for years afterward?

A new report published in JAMA says yes. In the study, women who had a history of sexual trauma were three times more likely to have depression and twice as likely to have anxiety compared to women who had never experienced sexual assault. In some ways, psychologists and mental health professionals say, it can be just as hard living with the aftermath of something more ambiguous—like a sexual assault in which you’re not physically harmed—compared to an obvious case of non-consensual sex or violence. Even instances of non-physical sexual harassment can have lasting effects on the people who are exposed to it, both emotionally and physically: Women in the new JAMA study who had been sexually harassed were more likely to have higher blood pressure and get worse sleep.

The accusations Ford has made may be high-profile, but they’re not unusual. The #MeToo movement has made it clear that behaviors like unwanted sexual contact, coercion, lewd comments, and unprompted advances are common—in the workplace, in social situations, and even within trusted institutions like schools, sports teams, and churches. Here are some of the major ways assault and harassment can take a toll on survivors’ health and well-being, and what they (and their loved ones) can do to heal.

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Anyone who’s ever experienced unwanted sexual advances or commentary knows that those words or actions can really stick with them—and if they happen repeatedly, they can have long-term effects on a person’s mood and mental health.

Research shows this may be especially true when the perpetrator is someone the person works with: A 7,000-person Danish study found that employees who are sexually harassed by supervisors, colleagues, or subordinates may develop more severe symptoms of depression than those who are harassed by clients or customers.

“People may feel ashamed or dirty or scared, they may pull back from society and from friends and family,” says Charles Sophy, DO, a Los-Angeles based psychiatrist and medical director for the County of Los Angeles Department of Children and Family Services. “Any underlying depression or anxiety can also get worse, and in the worst-case scenario it can result in injury to self.”

Sexual harassment can also lower people's self-esteem and body image—even if the comments or behaviors they’re exposed to are complimentary on the surface. “It’s all about power,” says Dr. Sophy. “Sexual harassers like to exert power over the victim, whether it’s a boss, a mentor, or someone with more money or higher stature.”

Unwanted sexual attention can also make existing body-image and self-esteem issues worse, according to a recent study in the International Journal of Public Health. The attention doesn’t have to be overly aggressive or offensive, either. “Even if it’s advances or comments that don’t actually come to fruition, sometimes that’s even worse,” says Dr. Sophy. “When harassment is subtle or non-concrete, other people might not take it seriously, and it can make the victim question whether it’s really happening.”

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Harassment can take the pleasure out of experiences survivors would otherwise enjoy and can cause them to withdraw from activities or stop going places they once loved. For example, in an Ohio State study of nearly 300 women who played online video games, women were more bothered—and were more likely to stop playing—when they experienced sexual harassment, versus general “trash talking” of a non-sexual manner.

“People can change their habits and totally alter their daily routines just to get away from this type of harassment,” says Christine Courtois, PhD, a trauma psychologist in Washington, DC. “Other times, they withdraw from everything and everyone—especially if their friends and family aren’t supportive and they don’t feel like they can talk about their problem.”

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The brain perceives sexual harassment as a threat, says Courtois, which triggers the body’s flight-or-fight response. When this happens, levels of the stress hormone cortisol skyrocket, which can leave a person feeling anxious, on edge, and defensive.

This can happen anytime a person perceives chronic stress or harassment, or feels unsafe for any reason. A 2015 Indiana University study, for example, found that women who work in predominantly male workforces show signs of cortisol dysregulation, likely because of the unique challenges (including sexual harassment and low levels of support) they tend to face.

Elevated cortisol levels can be protective in the short-term, but when stress becomes chronic, it can begin to affect a person’s physical health: Inflammation levels rise throughout the body, which can lower immunity and raise the risk for serious conditions like heart disease and cancer.

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The mental and physical effects of sexual assault and harassment can have long-reaching consequences on a person’s ability to form relationships, hold a job, and function in society—as evidenced by a 2016 study of men and women in the military. Individuals who had experienced sexual trauma during their service were more likely to be homeless after their deployment than those who hadn't, according to the research published in JAMA Psychiatry.

Other research has shown that the connection between homelessness and sexual harassment extends to people outside of the military as well—especially to women. Landlords may expect sexual favors in return for housing or making repairs, and tenants who refuse may face further harassment or even eviction. Many women in homeless shelters also end up there because of harassment or abuse from husbands, boyfriends, or other men in their life.

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Sexual harassment can also contribute to physical health problems. Recent research from the University of Pittsburgh, for example, found that women who had experienced three or more traumatic events in their life—including sexual harassment—had poorer heart and blood-vessel functioning than those with fewer traumatic experiences.

“I’ve seen enormous suffering and anguish as a result of sexual harassment, and on a few occasions I’ve seen it lead to major health crises—including heart problems and various surgeries,” says Courtois. “You might not think they’re connected, but when you look at the timeline of what’s happened, you can really see that these issues play an important role.”

Harassment on the job not only makes going to work uncomfortable; it can also hamper a person’s opportunities for advancement and their motivation to excel, which can have professional and financial consequences down the road. Studies—and recent news headlines—have shown this is a common problem, especially in male-dominated fields like scientific research, medicine, and technology.

According to a recent article in the Journal of Occupational Health Psychology, sexual harassment in the workplace is a chronic problem. Commenting in a press release, Antonio Puente, PhD, president of the American Psychological Association, said: “Organizations need to be proactive in establishing policies prohibiting sexual harassment, raising employee awareness, establishing reporting procedures, and educating employees about these policies.”

Some people who experience sexual harassment may lose weight because of disordered eating or loss of appetite, while others may turn to food for comfort and gain weight as a result. People who become isolated and depressed because of harassment may give up healthy behaviors like exercise as well, says Dr. Sophy.

Some sexual assault or harassment survivors even pack on extra pounds—intentionally or not—as a protective measure. Even after someone has escaped the person or situation that caused them to gain weight, losing it can be a serious challenge.

If you or a loved one has experienced sexual harassment and is suffering from these or other health issues as a result, the first step toward healing is talking about it with someone you trust, says Dr. Sophy. “Getting it out, verbalizing it outside of your body and your brain, can help tremendously,” he says.

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If you’re not comfortable talking to a counselor or a doctor, start with a supportive friend or family member. Eventually, talking with a mental health professional can help you develop tools and coping mechanisms for overcoming your trauma, escaping an unhealthy situation, and identifying any triggers that are affecting you on a regular basis.