What SARTs Should Know About Sexual Violence
This section of the Sexual Assault Response Team (SART) Toolkit provides an introduction to sexual assault and its impact on individuals and communities. It also introduces SARTs, which are teams comprised of the agencies that respond to reports of sexual assault.
SARTs should understand the full spectrum of sexual violence. Sexual violence  occurs when someone forces or manipulates another individual into unwanted sexual activity without their consent, which means they do not or are unable to give permission or agree to engage in a sexual act.  Broadly defined, sexual violence includes any type of unwanted sexual contact and can range from sexual comments and sexual harassment to sexual assault or rape.  This broad range of actions may or may not involve force and may or may not be classified as a crime in all states. 
Sexual assault is a crime that state, territory, federal, tribal, and military statutes define as a narrow scope of conduct involving penetration, contact, exposure, or exploitation. Criminal statutes are not uniform across jurisdictions. SART members should be aware of the criminal statutes related to sexual assault in their jurisdiction(s).
Some common elements in criminal sexual assault statutes include —
- whether force is required,
- how consent is defined,
- the age of the victim,
- the age of the person or people who committed the offense,
- the number of people who committed the offense,
- the relationship between the victim and offender,
- the intoxication of the victim,
- the incapacitation of the victim,
- the body part touched or penetrated,
- what was used to touch or penetrate the victim, and
- in some instances, the purpose of the penetration or contact; for example, humiliation or sexual gratification.
Civil laws and administrative codes may also define sexual assault and rape. However, violations under these laws and codes may not rise to the level of certain criminal laws. For more information about state and federal laws, see the section on Legal Definitions of Sexual Assault and SARTs in the SART Toolkit.
Anyone can experience sexual violence regardless of age, sex, sexual orientation, or gender identity. People who commit sexual violence are often people the victim knows and trusts. They can be acquaintances, family members, friends, or other trusted individuals such as caregivers, those in positions of power, and community leaders.
Results from the National Intimate Partner and Sexual Violence Survey found that almost half of female victims of rape had at least one perpetrator who was an acquaintance, and about 45 percent of female rape victims were raped by an intimate partner. Almost 45 percent of male rape victims were raped by an acquaintance, and about 29 percent of male victims were raped by an intimate partner.  A person who perpetrates sexual violence may use trust, force, threats, manipulation, coercion, drugs, or alcohol to commit sexual violence. Sexual assault affects a large part of the U.S. population.
- the subjugation and oppression of women,
- attitudes that condone violence,
- the use of power over others,
- traditional constructs of masculinity,
- silence about violence and abuse, and
- racism. 
Many factors contribute to the risk of being the victim of sexual violence. One particularly potent predictor is experiencing trauma and other adverse events during childhood. The Adverse Childhood Experiences (ACE) study shows that about two-thirds of adults report a history of one or more forms of adversity before the age of 18. Three findings from this research are especially important for SARTs to know: 
- There is a dose-response relationship between the number of childhood adversities reported and risk for later sexual victimization (i.e., as the number of reported childhood adversities increases, risk for sexual violence increases).
- Adults with a history of sexual abuse are more than three times as likely to experience sexual re-victimization than adults with no history of sexual abuse, making childhood sexual abuse the most potent predictor of adult sexual violence out of 10 types of adversities measured in the ACE study.
- The presence of other forms of childhood adversity (e.g., emotional abuse and neglect, physical abuse, family member with mental illness) contribute to risk for adult sexual victimization above and beyond what is conveyed by childhood sexual abuse alone.
- Some populations are at increased risk for childhood adversities, and SARTs should be aware of ACE studies in many aspects of their work. Visit the Victim-Centered Approaches section of the SART Toolkit, where some populations are introduced, including information on their lived experiences.
Legal Definitions of Sexual Assault and SARTs
SARTs should be aware that criminal sexual assault is largely defined by the jurisdiction in which the offense took place. Tribal, state, territory, and federal statutes, and military, campus, or institutional codes define criminal acts that constitute sexual assault. Rape, sexual assault, sexual battery, technology-based sex crimes, revenge porn, and sexual abuse are examples of those types of crimes.
Depending on the institution, such as on a school campus, codes may correspond to criminal legal definitions but do not create separate crimes. A victim’s location during an assault determines which law enforcement agency controls the investigation and which laws are applicable. The applicable laws define what actions constitute a crime.
To best serve victims of sexual assault, it is important that all members of a SART understand not only the broad definition of sexual violence but also the criminal definitions of sexual violence in their jurisdiction(s). Even if an act of sexual violence does not meet the criminal definition in a victim’s jurisdiction, a victim may still experience trauma or other consequences. SART members can be instrumental in helping victims get resources and understand their experience.
Prosecutors have the distinct task of determining if an act of sexual assault meets the legal standard to constitute a crime in a specific location. Prosecutors determine if the victim’s report will move forward into a formal charging and prosecution of a respondent or offender. This decision is based on many factors that are not always understood by victims, their families, or communities.
Prosecutors can meet with victims and their families directly to discuss the charging decisions that impact a victim’s case. Meeting directly with a victim and their family demonstrates support of victims and may help them understand the decisions made in a particular case, regardless of whether a prosecutor moves forward.
In jurisdictions where the prosecutor sends letters about charging decisions, victims may reach out to other SART members to better understand the decision. In these cases, it is important that other SART members can accurately discuss the possible reasons for the prosecutor’s decision, but it is the role of the prosecutor to ensure victims are fully informed.
Although a prosecutor may decide not to press charges, that does not mean a sexual assault did not occur. In some cases, the prosecutor may not have enough evidence to prove the case beyond a reasonable doubt. Sometimes sexual assault cases are difficult to prove, and it is not uncommon for a prosecutor to decline charges. By working together, SARTs can help identify common reasons prosecutors decline charges. SARTs can also work together to identify if these reasons are problematic or fall into harmful patterns.
SART members should treat each report of sexual violence carefully, with the same attention to detail, and by offering supportive services even if the reported violence does not rise to the level of a crime in their jurisdiction. The priority of a SART is to respond to all forms of sexual violence in a trauma-informed way. SARTs can also educate about sexual violence to change the culture that allows sexual violence to take place and affects the community’s ability to hold offenders accountable.
See the Sexual Assault Laws and Statutes Resources section in the SART Toolkit for additional websites that may support you in identifying the legal statues that are relevant in your state.
Federal Criminal Code
Federal courts have limited jurisdiction and do not usually prosecute sexual assault cases. However, federal courts do have criminal jurisdiction when sexual assaults take place on federal land (e.g., Indian Country, national parks, federal prisons) and when sexual assaults have interstate or international components (e.g., kidnapping cases, human trafficking, assaults on cruise ships). In some cases, laws and jurisdictions may overlap. For example, this happens when the victim is an inmate or a member of the military.
U.S. citizens sexually assaulted abroad will typically have their cases adjudicated under the laws of the country in which they were victimized. U.S. embassies may be helpful in identifying local or U.S. resources for victims living abroad. For more information on how to best serve U.S. citizens who are sexually assaulted abroad but seek to report at home, see Sexual Assault of Americans Overseas.
The Federal Criminal Code defines sexual abuse by the degree of force or threat of force used: 
- Aggravated sexual abuse includes circumstances when a person knowingly causes another person to engage in a sexual act or attempts to do so by using force or threatening a person with death, serious bodily injury, or kidnapping. Aggravated sexual abuse also includes situations in which a person knowingly renders another person unconscious or administers a drug, intoxicant, or other similar substance without the knowledge or permission of that person and engages in a sexual act.
- Sexual abuse takes place when a person knowingly causes another person to engage in a sex act by threatening or placing the other person in fear, or if someone engages in a sexual act with a person who is incapable of appraising the nature of the act or unable to give consent.
- Abusive sexual contact takes place when a person does not sexually penetrate the victim, but when he or she intentionally touches the victim’s genitalia, anus, groin, breast, inner thigh, or buttocks to abuse, humiliate, or harass the victim.
There is no federal definition of consent. Legally, the specifics of consent vary by jurisdiction, and SARTs need to verify the definition in their jurisdiction. However, SARTs should also understand commonalities of consent across jurisdictions, complexities, and legal ramifications.
Consent is an agreement to engage in sexual acts. Consent encompasses —
- the ability to give or withdraw consent at any time, even during a previously agreed-upon sexual activity.
- permission for the specific activity agreed upon. Permission for one activity does not imply permission for other activities.
- a specific act and each individual instance. 
Consent is a complex and evolving concept, and it is understood differently in different communities. Although consent must be voluntary, one of its complexities is defining when voluntary consent occurs. For instance, being in a relationship or having had a former relationship does not automatically imply consent.
Moreover, people may not be able to give voluntary consent to sexual activity for a variety of reasons, including— 
- fearing harm or retaliation from the perpetrator,
- being too young to give consent to sexual activity (as defined by state law ),
- having a medical condition that makes the victim unable to give consent,
- having a mental or developmental disability that prevents them from giving consent,
- being intoxicated to such an extent that it prevents their ability to consent,
- being physically unable to communicate unwillingness (unconscious, restrained, nonverbal, etc.), or
- having a severe mental impairment.
See the Consent Resources section for additional information on consent.
Consent in Court
Criminal laws related to sexual assault differ among jurisdictions.  The legal definition of consent varies considerably by state. Some jurisdictions have no definition of consent. These variances have serious ramifications. For instance, based on your jurisdiction, lack of consent alone may not meet the legal definition of sexual assault. Some jurisdictions require that the prosecutor prove lack of consent while others do not. Still others require lack of consent, use of force, and other conditions such as corroborating evidence (e.g., eyewitness, DNA, or other material evidence) before proving sexual assault. 
Consent is a key factor in most sexual assault cases, especially those involving an offender and victim who are known to each other. Often these cases hinge on one person’s word against the other’s, meaning one person says the sexual encounter was consensual and the other says they did not grant consent. The End Violence Against Women International (EVAWI) Law and Investigative Strategy: What Kind of Sexual Assault is This? course supports investigators in establishing a case beyond consent by exploring what additional evidence may be present.
Consent in the law, through both legislation and case law, has evolved over the years. Many recent changes counter rape myths and minimize victim-blaming attitudes. For example, many states now have statutes that say that the lack of physical resistance does not equate to consent. Many states have laws that prohibit a victim’s sexual history from being discussed at trial. These are commonly referred to as “rape shield laws” and are supported by Federal Rule of Evidence 412. At times, under the law, a victim’s prior sexual activity, although protected, may be deemed relevant to determine whether she consented to the perpetrator’s conduct.
There are many aspects of DNA evidence, and it does not provide definitive evidence of consent. DNA evidence can only verify that two people had a physical or sexual encounter.
SARTs need to be aware of the laws that govern their jurisdiction and know how they are enforced through investigation and prosecution. SARTs can review laws to identify those that present an extreme burden for victims, cause routine challenges for prosecution, or otherwise impact community safety.
A SART may identify an opportunity to update legislation, educate the community about existing legislation, or inform legislative updates. A SART may also identify opportunities to conduct community education related to consent, both as prevention and education.
Understanding National Sexual Assault Data
Incidence and prevalence of sexual assault is difficult to measure, as gathering accurate information on national sexual assault statistics poses many challenges. Sources for national rape statistics often draw from criminal justice data, instances of rape reported to law enforcement, or behavioral studies. Rates of sexual assault can vary across reports and surveys due to reporting patterns, differing state definitions, and differences in population variables such as the age range of victims surveyed.
In 2015, it was estimated that over 67 percent of rapes were not reported to police.  Most of what is known about sexual violence is from victims’ perspectives. Existing information on people who commit sexual offenses comes from individuals who have been arrested, convicted, or adjudicated for sexual crimes. Very little information exists from those who commit sexual violence and never enter the criminal justice system.
The Government Accountability Office report, Sexual Violence Data: Actions Needed to Improve Clarity and Address Differences Across Federal Data Collection Efforts, provides more information on federal data collection efforts.
Sexual Assault Laws and Statutes Resources
This resource provides training and technical assistance to improve the quality of justice in sexual violence, intimate partner, stalking, and human trafficking cases. AEquitas staff can review and analyze statutes upon request.
The Rape Abuse Incest National Network (RAINN) website features an interactive map that allows the user to research states laws on sexual assault and rape. It includes information on how states define rape, sexual assault, and consent; laws related to mandatory reporting; and statutes of limitations for sexual assault crimes.
This resource provides information about tribal law and culturally relevant issues, including the training of personnel who handle sexual assault crimes and the development of policies and materials specific to each tribe's language, values, customs, and traditions.
This website addresses confidentiality, reporting procedures, and other elements of the Department of Defense's sexual assault policy, and provides training information, safety tips, and resources.
Policy Resources for Schools and Universities
Know Your IX is a survivor and youth-led organization focused on ending sexual and dating violence in high schools and institutions of higher education. The organization provides education and training, and advocates for policy changes at the campus, state, and federal levels to end violence.
Stop Sexual Assault in Schools is an organization dedicated to addressing sexual harassment and the rights of students at the K-12 level.
>Consent 101 (multimedia)
This video series by Planned Parenthood explains consent and how to know if you have consent for sexual activity.
Consent: It’s Simple as Tea (multimedia, 2:49)
This short video explains consent using tea as a metaphor.
RAINN provides information and specific examples of what consent looks like.
This seven-minute video by the Office for Victims of Crime (OVC) provides a brief introduction to this topic.
This two-part webinar series recorded by AEquitas provides strategies for investigators and prosecutors who handle drug- and alcohol-facilitated sexual assault cases.
AEquitas provides this document summarizing state laws of sexual assault of an intoxicated victim.
End Violence Against Women International developed this training model that helps investigators determine whether a person accused of sexual assault has committed sexual penetration or sexual contact; whether any reported sexual acts (whether penetration or contact) were committed using force, threat, or fear; and whether the situation was one in which no force was required for sexual acts to constitute a criminal offense given the category of sexual case being handled.
The webinar also predicts the defense most likely to be raised and presents an investigative strategy designed to overcome a particular defense.
RAINN’s website provides information about the legal role of consent.
AEquitas created this webinar that focuses on strategies to successfully prosecute cases of sexual assault where the offender is the victim’s intimate partner.
Being Smart About Statistics (e-learning course)
This online course by PreventConnect provides information on how to identify quality statistics and how to use them appropriately.
Incidence and Prevalence of Sexual Offending (Part I) (PDF, 6 pages)
This 2016 U.S. GAO report highlights the differences in federal data collection methods on sexual violence.
This 2009 report from the Centers for Disease Control and Prevention (CDC) details the issue of varying definitions across survey collections on sexual violence and provides a list of uniform definitions to aid in data collection.
Using Statistics to Support Your Work (PDF, 11 pages)
This resource by the Washington Coalition of Sexual Assault Programs offers tips on using and analyzing statistics.
Understanding the Effects and Costs of Sexual Assault
To fully support victims, SARTs should review the myriad serious effects of sexual assault on victims. Victims, agencies, employers, and communities experience immediate and long-term costs when sexual assault is committed. Sexual assault has significant emotional, physical, and economic consequences on victims and communities. The effects of victimization touch not only the victim but also families, colleagues, neighbors, acquaintances, social service providers, and the criminal justice system. Recovery may require working through physical, mental, emotional, and spiritual concerns.
The work of SARTs in building collaborative and effective responses to sexual assault can help minimize costs at each level and across every dimension.
Understanding How Victims React to Trauma
It is fundamental that SARTs understand that when a person is harmed by a criminal act, the criminal justice system has a moral and legal obligation not only to seek justice but also to respond with respect and compassion to the unique needs of traumatized victims.  Research on trauma’s biological effects on the brain has yielded important insights. It is critical that SARTs recognize the powerful effect sexual assault may have on victims and integrate trauma-informed, culturally responsive, victim-centered approaches into their responses.
Service providers should be aware that when an attack is detected, the brain’s defense circuitry may —
- rapidly take over,
- immediately impair the rational part of the brain, and
- trigger the release of habit and reflex behaviors.
These natural, brain-based habit and reflex responses determine the ways a victim behaves during an assault. Misunderstanding biological responses to attack, including sexual assault, can result in additional trauma for the victim, undermine investigations, and prevent holding offenders accountable in court.
Being physically and emotionally violated during a sexual assault can cause states of intense fear, powerlessness, and hopelessness, in part because the internal resources that give individuals a sense of control, connection, and meaning are overwhelmed. 
This section of the SART Toolkit reviews brain-based and emotional responses to sexual assault, coping strategies, and a trauma-informed response to victims of sexual assault.
Brain-Based Responses to Trauma
Recent research has discovered common, brain-based responses to events the brain interprets as an attack, including sexual assault. This knowledge about how the brain processes threats and attacks has implications for sexual assault victims and the work of SARTs in building victim-centered services and supports.
It is impossible to understand the complex ways the brain works by referring to a few of its parts and their functions. But the brain’s response to an unsafe situation or attack can be greatly clarified through an understanding of the prefrontal cortex and the “defense circuity.”
The prefrontal cortex is behind our foreheads and above our eyes. When the prefrontal cortex is fully functioning, it allows people to have thoughts and behaviors that are not simply based in habits and reflexes. For example, the prefrontal cortex allows us to focus our attention where we choose, based on our goals for a situation or interaction. The prefrontal cortex is what allows us to be “rational” by drawing on memories and plans, as well as reasoning capacities, to make decisions about how to respond to a situation or interaction.
The brain has a “defense circuitry” long referred to by scientists as the “fear circuitry” (including the amygdala), which is the most important circuitry for understanding how and why people respond to sexual assault, physical assault, combat, and other situations involving threat, attack, and other dangers. The defense circuitry continually monitors the environment for signs of danger, threat, or attack. When that circuitry detects an attack, within a second or two, it can dominate brain functioning. 
When the defense circuitry takes over, a person’s behavior is largely controlled by habits  and reflexes,  not behaviors chosen by the brain’s “rational” prefrontal cortex, which is rapidly impaired in situations of high stress or fear.  This makes perfect sense: It takes time to think of rational responses – time that could mean the difference between life and death – but habits and reflexes can be accessed and deployed in less than a second, as any well-trained police officer or military service member knows.
The rapid responses by the “defense circuitry” often follow a pattern over time, beginning with reflexive freezing, followed by habits or other reflexes determined by how the defense circuitry is assessing the unfolding threat or attack.
Freeze is typically the first brain-based reflex response during a sexual assault. This is usually a brief response that kicks in when danger or attack is detected, in which movement is put on hold and the brain scans the environment to assess for danger and possibilities for escape.
For example, the freeze response can happen if a victim suddenly realizes that someone they trust is betraying that trust. Or it can occur when the victim realizes that someone does not care what the victim wants or does not want done to their body, and refuses to acknowledge, or will not listen to, any version of “no.”
Importantly, the initial and typically brief freeze response should not be confused with other reflex or habit responses that involve not moving. The initial freeze is an assessment, while specific defense and survival mechanisms (e.g., tonic immobility, as described below) may be implemented by a victim’s brain later in an assault.
After the initial freeze response passes (which could take just a second or two), the brain’s defense circuitry can rapidly select from a variety of other reflexive and habit-based response options. These reflexive or habit-based responses could include “fight” (physical resistance of some kind) or “flight” (attempting physically to escape), or fleeing. But fight and flight are not the typical responses of sexual assault victims, especially when they’re assaulted by someone they know and thought they could trust, which is most commonly the case.
When a serious threat or attack is detected, the brain’s defense circuitry (1) rapidly takes over, (2) impairs the rational part of the brain, and (3) triggers the release of habit and reflex behaviors.
Everyone has habits of self-protection that are based in culture or times in their lives when they were abused, attacked, dominated, disempowered, or oppressed. For example, many cultures teach individuals to initiate and pressure others for sex. Some cultures teach responding to unwanted sexual advances with polite excuses (e.g., “it’s late,” “my partner will find out”) rather than saying “no.” In some cultures, individuals are taught “no” does not mean stop.
Victims of childhood sexual abuse may react to an adult sexual assault with the habits developed during the childhood abuse because those habits “worked” — not to stop the abuse, but to keep the victim alive or to prevent others from experiencing the same abuse. Old habits from traumatic childhoods often involve behaviors of submission and silence.
Victims may say “no,” move away, ask to be brought home, suggest another activity, or otherwise indicate a lack of consent precisely because they are terrified, and their brain has no other habits (such as from sexual assault resistance training ) to draw upon.
Self-protection habits can come back, in a fraction of a second, once a sexual assault is detected by the brain’s defense circuitry, even if they have not have been activated for years. Too often, the habit behaviors employed during sexual assaults are later misunderstood or interpreted as evidence that no assault occurred, or that the sexual contact was wanted.
People who committed the assaults and defense attorneys often use the lack of education and clarity around habit responses to introduce doubt and claim that victims had “mixed feelings” at the time and only later claimed it was an assault because they regretted their behavior.
In other cases, the brain’s defense circuitry initiates extreme “survival reflexes,” also known as “defense responses,”  that have long enabled animals and humans to survive attacks by larger predators that want to eat them (or not feel pain while being killed). Unfortunately, when someone is being preyed upon sexually, these extreme survival reflexes render them even more vulnerable to the offender.
Commonly misunderstood extreme reflexes that occur during sexual assaults are described below. The most common is dissociation. Tonic immobility is less common, and collapsed immobility is least common of all but occurs in some cases.
- Dissociation. The brain disconnects conscious awareness from the terrible sensations and emotions that the sexual assault is causing in the body. The person “blanks out,” or “spaces out,” and later may say they felt like they were “in a dream,” “in a movie,” or “disconnected from my body.”
- Tonic immobility. The person is literally paralyzed, unable to move or speak. Muscles are rigid and may tremble. The person may be fully aware of what’s happening to them, including horrific sensations and emotions, but utterly helpless to do anything to stop it, even to call for help. The person may simultaneously dissociate and not experience what’s being done to and happening in their body — typically, a state of total paralysis, but some victims report being able to slightly move parts of their body. Also, victims can quickly go into and out of this state, paralyzed one moment and able to move the next.
- Collapsed immobility. Due to sudden massive drops in heart rate and blood pressure that characterizes collapsed immobility, the brain receives less oxygen and the person feels faint and may completely pass out. They are also paralyzed, unable to move or speak, with the body limp or floppy (not rigid as in tonic immobility). Given the loss of oxygen to the brain and impacts on consciousness, it takes time to emerge from this state.
It is essential that service providers understand the brain-based responses to sexual assault so they can understand victim reactions and develop support and services that treat victims with fairness, respect, and dignity.
Introduction to the Science of Stress, Trauma, and Memory
To get the most accurate information about the assault, SART members, specifically investigators and prosecutors, should understand how victims may record information at the time of the assault and later remember it. When considering a victim interview strategy, you need to consider memory decay versus retrievability, and balance the potential costs and benefits of a single interview versus multiple interviews.
Investigators also need to consider what a stressed victim may be able to recall and share soon after an assault versus what the victim may be able to recall and share in an interview after adequate sleep. In light of emerging science and refined understanding of memory, law enforcement may begin to implement and evaluate multiple trauma-informed interviews. As this is an emerging practice, SARTs are encouraged to seek up-to-date information from technical assistance providers on outcomes to ensure SARTs are implementing current best practices when interviewing victims.
Here are some reasonable implications of the research on memory, stress, sleep, and “retrieval practice”:
- Victims who are still traumatized or very stressed after a sexual assault (or other trauma) will not be able to recall everything that was recorded by their brains, even when interviewed with the best and least stressful possible approach. At least two interviews over the span of several days may yield more information. More information from a victim may help investigators build a more robust criminal case. Investigators following trauma-informed interview practices, including asking open-ended questions, and not pushing for recall of peripheral details that may not have been encoded, can worry less about multiple interviews creating inconsistencies.
- Aside from the impairing effects of stress on retrieval of memories (which are important), the longer one waits to interview a sexual assault victim, the less likely the victim is to remember peripheral details. Peripheral details are details from the assault that were not central focuses of attention or emotionally significant — yet could still be critical to the investigation and prosecution. Waiting for the victim to sleep is not going to help preserve those peripheral details in memory, unless before sleeping the victim has retrieved those details and their brain has tagged them as emotionally significant. 
- The stress-reduction benefit of sleep could enable the retrieval of some information that was not accessible before the victim slept. This is particularly true for the memories that are most emotionally significant, which sleep helps to preserve, while emotionally insignificant information may continue fading and even be lost during sleep.
- Even if the victim is too traumatized or stressed to recall some details in the first interview, those details that are retrieved in that first interview will be re-encoded and potentially “re-consolidated.” Especially for parts of the experience associated with less attention or little emotional significance during the assault, that first interview could preserve critical information that would otherwise be lost.
- For all interviews with sexual assault victims, anything that significantly stresses victims will make it harder for them to retrieve whatever memories are still stored in their brains.
It is critical that SART members, including investigators and prosecutors, distinguish between central and emotionally significant details versus peripheral and less emotionally significant details. The former tend to have stronger encoding and sleep-promoted “consolidation” (or storage) and to be less easily distorted by poor interviewing or associated with inconsistencies. The latter tend to be poorly encoded, not consolidated by sleep, and vulnerable to confusion and inconsistencies despite sincere and honest efforts of victims to remember, especially if investigators ask leading questions or push for information that was never encoded or is no longer retrievable.
The following section of the SART Toolkit, Understanding the Science of Stress, Trauma, and Memory, gives SARTs more detail on memory science and its implications.
Understanding the Science of Stress, Trauma, and Memory
Expert Interview - Why Should Law Enforcement Understand Trauma? - James Hopper by End Violence Against Women International, 2018. Retrieved from LINK. Provided with permission.
Stress and trauma can both enhance or impair the initial encoding (i.e., information getting into short-term memory during the event) and longer-term storage of some aspects of a sexual assault in memory. The same “stress chemicals” that the defense circuitry releases to impair the prefrontal cortex (so habits and reflexes can control behavior) can alter how different aspects and phases of the assault are encoded and stored into memory – or not.  During a sexual assault, the brain encodes and stores some information, such as what may be necessary to predict and therefore avoid future attacks by perpetrators, but not other information.
Stress and trauma can enhance the encoding and storage of some aspects of a sexual assault. This has important implications for investigations because victims often have quite full, vivid, and accurate memories for the initial phase of the sexual assault, right before and after the defense circuitry took over and the stress and fear kicked in. Stress and trauma can “burn in” things experienced right before and after the assault was first detected, or aspects of the experience that were particularly frightening, upsetting, or otherwise emotionally significant. 
Stress and trauma can impair the encoding and storage of other aspects of the sexual assault. This includes parts of the experience that received little attention or emotional significance at the time, and aspects that require greater processing, such as the order of events. Such impairment tends to happen especially after the hippocampus leaves the “super-encoding phase” that kicked in when the attack was first detected (also when the freeze response happens).  When “impairments” interfere with forming memories of a sexual assault, they are part of proper and generally adaptive brain functioning. 
SART members must have realistic expectations of victims’ memories — expectations rooted in knowledge of how the brain responds to attack, stress, and fear. At the same time, always keep in mind that every victim and every assault is unique and, although unusual, some victims report vivid and relatively complete memories of what happened throughout an assault.
Service providers need to understand that alcohol and drugs, like stress and trauma, can impair memory for some aspects of an assault experience but not others. Moderate levels of alcohol or drug intoxication can impair encoding and storage of complexities like the time sequence but not impair the recording of what the victim’s brain focused on or what was most emotionally significant. 
It is critical not to assume that intoxication resulting in some memory impairment renders all of a victim’s memories unreliable. Particular details of the assault experience — for example, aspects of the experience that were particularly disturbing or a main focus of attention, also known as “central details” — may be very well encoded and stored by moderately intoxicated victims.  That is usually not true of peripheral details, which are those that had little or no emotional significance during the assault or got little or no attention.
Even in states of severe intoxication, which leave the victim with minimal memories, the most disturbing or distressing aspect of the assault (including dashed hopes of being rescued by a bystander) can sometimes get enough of an additional “boost” from stress chemicals released by the defense circuitry  to be recorded vividly and accurately into memory.
For all these reasons, memories of trauma can be fragmentary, and it can be difficult for victims to recall details of a sexual assault in a complete or linear way. Victims or witnesses may recall some specific sensory details from particular aspects of the assault — sights, sounds, smells, tastes, touch — but little or nothing about other aspects. For example, a victim may remember the colors of the perpetrator’s tattoo but not their shirt; or a victim may not be able to remember how long the assault lasted or the order in which some things happened. Those are normal limitations of memory caused by stress, trauma, and substance intoxication.
Victims may take hours or days to successfully recall memories of sexual assault. A major reason is that stress impairs retrieval of memories for events.  A victim interviewed shortly after an assault, or while still very stressed or traumatized, will not be able to retrieve everything that has been encoded into her or his brain. Critically, if a victim is interviewed in a stressful way (e.g., without compassion, with interruptions of their narrative, with expressions of doubt about what they are reporting), they will not be able to recall potentially crucial information that is stored in the brain. Read the Trauma-Informed Response section of the SART Toolkit for more information.
SART members interviewing victims should also consider the beneficial effects of sleep on memory retrieval. Once parts of an assault have been encoded into memory, those “pieces of memory” will begin to fade or decay, or at least become harder for people to recall. This is because additional brain processes are required to “consolidate” or preserve their storage so they can be recalled later.  Researchers have found that such consolidation partly depends on sleep,  and critically, that such sleep-related consolidation only applies to emotionally significant parts of the experience.  These emotionally significant events, or central details, could be anything a victim focused on during the assault.  This means that anything experienced as a peripheral detail,  or emotionally neutral or insignificant during the assault, will not benefit from consolidation during sleep and, all other things being equal (e.g., stress), those peripheral details will keep getting harder to recall.
Multiple interviews and open-ended questions support more complete retrieval. The best way to store and preserve pieces of memory that would otherwise become less and less accessible for retrieval is to retrieve them into awareness.  Each time memory pieces are retrieved — for example, in response to an open-ended question from an investigator — they are literally re-encoded into the brain (and potentially re-consolidated). This makes these memories more likely to be available for recall later.  A recent study suggests that prior retrieval can even protect peripheral details and originally emotionally insignificant information from decaying and becoming less accessible to retrieval. 
Everyone on your SART should be able to distinguish between central and peripheral details. It is important that SARTs build on best practice regardless of what interview method is being used in your SART’s jurisdiction, if your SART is making a change, or if your SART is engaged in a project to evaluate different interview methods for victims of sexual assault.
SART members should also be aware of the effects of triggers, which are traumatic emotional cues, on the efficacy of an interview. At the sound, touch, or sight of those cues, victims can experience the same surge of neurochemicals present during the actual assault. The victim’s heart may begin to race, their blood pressure may spike, and their breathing may accelerate. They may find themselves wanting to flee from a health care facility or freeze in terror because law enforcement or a forensic examiner asks them specific details about the assault.
These fear reactions are not conscious choices or overreactions any more than such reactions were during the assault. They are automatic responses triggered by traumatic memories, indicators of a brain that is primed for detecting and defending against attack.
In light of the effects of these triggers, it is crucial for SARTs to provide and seek information at a pace that does not significantly stress or overwhelm victims.  SART members can learn to slow down or stop a process if a victim’s emotional state changes and ask what the victim needs to feel safe and relatively calm during that moment. SART members can support victims’ identification of triggers by explaining the impact of trauma and providing referrals to mental health professionals or advocates. The following section gives SARTs more information on how triggers affect victims.
A trigger may be any external or internal experience that is similar to an aspect of the sexual assault or otherwise reminds a victim of the assault. Triggers could be a tone of voice, a look of disgust by a family member, a specific smell, an unwanted touch, or hearing about someone sexually assaulted on the news or at the movies. The anniversary of an assault can also be difficult for a victim due to triggers and memories related to the date.
The short video, What are “triggers” when dealing with Post Traumatic Stress? , describes the range of trauma triggers. While this video is related to combat post-traumatic stress disorder (PTSD), the information is relevant to sexual assault victims as they represent the largest non-combat group of individuals with PTSD. 
Victims are exposed to potential triggers repeatedly in daily life. Throughout the civil or criminal justice process, victims are exposed to many potential triggers when they are asked to recount their traumas, appear in the courtroom along with assailants, and answer intrusive personal questions.
Many victims are able to discover what their triggers are and make plans to avoid and be prepared for challenging situations. However, sometimes victims are not aware of their triggers. For example, a victim may be tense when hearing a song, not realizing it was playing the night of the assault. This can make it difficult for a victim to identify and be prepared for all the potential triggers resulting from an assault. Sympathetic and informed responses from SARTs can greatly improve these situations.
During a sexual assault, a victim may experience many intense emotions, including fear, disgust, horror, shame, and anger. But many victims also dissociate during the assault and have no awareness of any feelings — at least while they are in that dissociated state. 
In the aftermath of the assault, victims’ emotions can vary greatly and they can go through cycles of emotions in a grieving process. There is no one “normal” response to trauma; in fact, a variety of responses are normal. Victim responses depend on the individual and on the people around them (e.g., how supportive they are). Some common responses are — 
- feelings of unreality,
- self-blame, and
One common emotion among victims is anger. When victims begin to acknowledge that they were violated, had no control over what happened, and were not to blame, they may experience intense feelings of anger. This is a very common response to trauma, as it can provide energy to persevere. Victims may experience anger through— 
- arousal: A physical reaction that may make them feel constantly on edge.
- behavior: Victims may act aggressively toward themselves or others.
- thoughts and beliefs: Victims may think they cannot trust anyone or that no one will protect them from harm.
Another common response is a feeling of loss and sadness. When victims process their feelings, they may be sad or feel helpless. At this stage, they may feel they have lost — 
- bodily autonomy,
- self-worth, and
- friendships or relationships.
Victims may grieve after a sexual assault much like they would grieve the loss of a loved one. The most common stages of grief are — 
- depression, and
The grieving process can take time and is not linear, as stages can reoccur.
SARTs should also know that victims may have experiences of dissociation and show no outward signs of emotional trauma. This can be confusing to friends, family members and professionals. Expected emotions and behaviors such as shaking in fear or crying may be completely absent, and this can result in others not believing the victim or not believing that what happened was an assault or traumatic. This can lead to victims doubting themselves too: If they do not feel the emotions connected with the assault, the assault itself may not feel real.
Victims may have continued contact with perpetrators, or delayed responses that are completely different from how they responded initially (e.g., dissociated for days or weeks, then suddenly terrified or angry). Although some may perceive these reactions as counterintuitive, they are very common and well-known responses to trauma.  The neurobiological bases are not well understood, but they do exist and have been studied, particularly with brain-imaging technology. 
Sometimes victims display emotions that seem completely at odds with sexual assault and trauma. Some people laugh when they are nervous or afraid, even ashamed, and this can happen after being sexually assaulted. Such emotional behaviors should never lead others to assume an assault did not happen. In fact, victims who exhibit such responses should be treated with particular sensitivity and compassion, because they are likely to be embarrassed and ashamed that they are laughing in such a situation.
As with dissociation, the brain bases of laughing and silliness after sexual assault are not well understood, and cannot be attributed to any particular chemicals in the brain. See the Brain-Based Responses to Trauma section of the SART Toolkit for more information.
Many post-assault emotions result from victims’ attempts to make sense of what happened and how they responded during the sexual assault. Immediately following an assault, many victims question whether the act they experienced was really assault and why it happened to them. The shock of the assault is often followed by additional questions that victims may or may not articulate out loud, such as —
- should I tell anyone?
- am I losing my mind?
- why am I unable to cry?
- what if I had done something differently?
- will I ever get over this?
- why me?
Many individuals are concerned about — 
- not being believed.
- family, friends, employer, or community finding out.
- losing their job because they seek medical care.
- losing their job to make appointments related to the assault.
- losing their job, if they are in the military. 
- being “outed” to their communities, if they identify as LGBTQ. 
- the perpetrator retaliating.
- their name being reported in the news.
- getting in trouble for illegal drug use or underage drinking.
Due to these fears and more, sexual assault can be extremely isolating. Victims may feel angry and distrustful of help. When they disclose their assaults, they often risk disbelief, scorn, shame, punishment, and others’ refusal to help.
SARTs need to understand the complex issues that victims face prior to making the decision to report. SARTs have an opportunity to provide individuals with compassionate and emotionally supportive care that may decrease instances of trauma and increase willingness to seek help and engage with law enforcement.
Whenever a victim discloses, it is essential to be aware of various coping strategies and ways SARTs can assist victims by offering information about healthy ways to manage the effects of an assault. Victims may need support to make healthy coping strategies a viable option, such as transportation to a support group or help finding affordable alternative healing modalities such as dance therapy or yoga. Follow-up care and ongoing contacts provide further opportunities for SARTs to help victims develop positive means of addressing their trauma response.
This section of the SART Toolkit gives an overview of how victims cope in both positive and negative ways. Coping strategies are specific efforts people employ to master, tolerate, reduce, or minimize stressful events.  Sexual assault victims often rely on coping strategies they’ve used in the past.
A common coping strategy for many victims is continuing their day-to-day routines immediately following the assault and choosing not to tell anyone or tell very few people. It is normal for victims of sexual assault to disclose to a trusted friend or family member before seeking advocates or medical care, or reporting to law enforcement.
One study of women who had experienced sexual assault found that a quarter of victims only disclosed their victimization to someone after a year or more had passed.  Another study of childhood sexual abuse victims found that roughly a third of female victims and almost three-quarters of male victims did not disclose their victimization to others at the time of the abuse, with 44.9% of victims waiting more than 20 years to disclose. 
Victims of sexual assault and other traumatic events may “ignore” or try to manage the effects of the trauma and suppress emotions associated with the trauma for many years.  Victims who appear to “ignore” an assault may be doing so as their brain is not able to process the trauma, or the feeling of being unsafe that is associated with the memory of the assault. If and when victims do choose to disclose, victims may feel the same threat or attack they experienced during the assault or as though the assault happened very recently. It is best practice to treat victims with trauma-informed care, whenever a service provider receives a report of sexual assault.
Victims may seek a variety of coping strategies, both unhealthy and healthy, to manage their lives.
Unhealthy coping strategies include — 
- self-medicating with alcohol and other addictive substances,
- compulsive shopping,
- eating disorders, and
- compulsive or risky sexual activity.
Healthy coping strategies that some victims have found therapeutic include — 
- attending support groups,
- participating in therapies like yoga or equine therapy,
- talking with friends or family,
- praying or meditating,
- expressing creativity through art, drama, music, dance, etc.,
- seeking assistance from the justice system (pressing criminal charges, obtaining protective orders, filing lawsuits, and pursuing restorative justice to hold offenders accountable),
- taking action through helping others or taking a self-defense class,
- trauma resolution therapy, and
- cultural practices.
There may be barriers to using some of these coping strategies. For example, people who identify as part of a minority ethnic population or individuals living in poverty may not trust the criminal justice system or be able to afford therapy.
SARTs can be supportive of victims’ emotional needs by partnering with organizations locally and nationally to develop a meaningful referral network to meet a victim’s individual needs. For instance, SARTs can connect with their state’s Crime Victim Compensation to understand if and when assistance for therapy payments is available.
Most victim responses, given what we now know about the neurobiology of trauma memory and response, are actually very common and completely normal given the abnormal experience of sexual assault.
All members of your SART should understand the impacts of trauma and how to incorporate trauma-informed principles into their work with victims. While there is no one universal approach to the specifics of service delivery, it is important that all responses by a SART be victim-centered and trauma-informed. SART members can engage in trauma-informed care of victims regardless of whether the offense rises to the legal level of a chargeable crime.
A traumatic event can cause physical, emotional, or psychological harm. “Trauma-informed” is understanding the impact trauma may have on a survivor and using that information to view, talk about, and develop systems that —
- provide services to victims of trauma in a way that is responsive and supportive to victims experiencing trauma,
- provide services to victims in a way that allows individual providers to adapt services based on the trauma response and subsequent needs of individual victims,
- do not cause additional trauma to victims, and
- help victims heal.
Sources of trauma can include current or prior trauma from sexual assault, domestic violence, war, traumatic accidents, parental abandonment, prison stays, terrorism, physical pain, illness, divorce, natural disasters, death of a loved one, genocide, oppression, colonization, and historical trauma. For more information on the trauma response, see the Understanding How Victims React to Trauma section of the SART Toolkit.
How to Build Trauma-Informed Care into Practice
In order to provide trauma-informed care, SARTs can analyze all aspects of service delivery from the perspective of the victim, asking, “What might this experience be like for someone in a traumatized state?”  Asking this question of all aspects of response will enable SARTs to adjust services to accommodate the realities of biological and emotional responses to trauma and will help prevent re-traumatizing victims through insensitive responses.
SART members should also take the cultural and community identities and experiences of victims into consideration so that they are prepared to serve individual victims in a meaningful way. Understanding that different victims will require different services enables SARTs to be prepared to meet those needs by providing options that honor the victim as an expert in their own life and encourage the victim to choose what is best for them. 
It is best practice for SARTs to include trauma-informed principles in all aspects of their work, including with other team members who may be experiencing vicarious trauma. Being trauma-informed encourages service providers and agencies to lead with empathy.
SARTs should ensure that all responses to sexual assault incorporate the core principles of trauma-informed services, which can include the following: 
- Safety: Ensure physical and emotional safety of victims and identify victim needs. Provide services in easily accessible locations. Signs, visuals, and other printed materials are easy to read, welcoming, and reflect different populations.
- Trust: Maximize trustworthiness by providing the victim with clear information about what will be done, by whom, when, why, under what circumstances, at what costs, etc. Ensure all members of your SART clearly understand their role.
- Choice: Prioritize victim choice and decision-making and support victims’ control over their own healing journeys.
- Collaboration: Maximize collaboration within organizations and between SART members and share power with victims.
- Empowerment: Identify a victim’s strengths and prioritize skill-building that promotes victim healing and growth.
- Cultural competence: Ensure cultural applicability of services and options and sensitivity to the role of culture in lived experience and decision-making.
Some practices include — 
- team members identifying themselves and their roles.
- explaining any limits to confidentiality before any disclosures are made.
- asking simple grounding questions, such as, “Would you like a glass of water?” 
- not expecting a linear description of the assault, especially in initial interviews.
- asking what the victim can recall or what they physically felt or saw. 
- giving the victim time to process through the event.
- checking in throughout the process to assess how the victim is doing.
- creating a safe and comfortable environment.
Trauma-Informed Approach Resources
Adult Sexual Assault: A Trauma Informed Approach (multimedia, 22:48)
The NSVRC provides a film that gives an overview of how trauma impacts victims and how law enforcement and first responders can implement trauma-informed responses. A Facilitator’s Guide is also available. 
This resource from NIWAP provides guidance on how people working with survivors can collect their stories.
This portal from End Violence Against Women International includes webinars, articles, online courses, and more on trauma-informed interviewing techniques.
How Trauma Lodges in the Body (multimedia, 52:05)
This podcast features an interview with Dr. Bessel van der Kolk about the impact of trauma on the body.
The International Association of Chiefs of Police (IACP) presents a training to equip law enforcement with an understanding of the neurobiology of trauma.
This resource developed by the National Immigrant Women’s Advocacy Project (NIWAP) was developed by drawing upon evidence-based research on violence against women, coercive control, trauma and acculturation.
Neurobiology of Sexual Assault Resources
EVAWI hosted these 90-minute webinars in September 2016 by Jim Hopper, Ph.D., who has studied the neurobiology of trauma with brain imaging technology. Part 1 covers brain-based but commonly misunderstood victim experiences and behaviors, including impaired reasoning, freezing, and tonic immobility. Part 2 covers brain-based impacts of stress and trauma on memory encoding, storage, and retrieval.
Jim Hopper, Ph.D., answers 16 common questions asked by law enforcement officers, prosecutors, and other professionals, published by EVAWI in October 2016.
The National Institute of Mental Health page on post-traumatic stress disorder (PTSD) reviews the diagnosis in detail, with a list of symptoms and additional information.
This online learning course by the NSVRC provides an overview of the neurobiological and psychological impacts of sexual violence and offers skills for trauma-informed service delivery.
This website from the Washington Coalition of Sexual Assault Programs discusses neurobiological reactions to trauma.
Resilience Resources for Victims
RAINN’s website provides explanations of common responses to sexual assault, including depression, flashbacks, PTSD, and more.
OVC Help Series for Crime Victims: Sexual Violence (PDF, 2 pages)
The Office for Victims of Crime’s brochure provides an overview of sexual assault services generally available to victims.
Reach In. Reach Out. Finding Your Resilience (PDF, 8 pages)
The National Center for Victims of Crime provides this document explaining resiliency, the power to cope with adversity, and some concrete ways to build resilience.
The American Psychological Association website describes resilience and some factors that affect how people deal with life-changing and stressful situations. It includes lists such as “10 ways to build resilience.”
Trauma Response Resources for SARTs
This blog post from the Pennsylvania Coalition Against Rape explains common reactions and behaviors exhibited by survivors, including why they may continue having contact with the perpetrator.
This handout by Jim Hopper, Ph.D., provides advocates and service providers with basic information on brain function in an easy-to-share format.
This website from Sexual Assault Training and Investigations addresses why victims may make incomplete, inconsistent, or untrue statements to law enforcement and discusses how to overcome the challenges such statements pose to an investigation.
This article, from AEquitas: The Prosecutors’ Resource on Violence Against Women, discusses trauma-informed techniques for law enforcement and prosecutors.
Toolkit to End Violence Against Women (PDF, 233 pages)
This toolkit developed by the National Advisory Council on Violence Against Women contains recommendations for strengthening prevention efforts and improving services from numerous experts in the fields of sexual assault, domestic violence, and stalking.
The Impact of Trauma on Brain, Experience, Behavior and Memory (PDF, 14 pages)
This handout created by Jim Hopper, Ph.D., answers the most common questions related to victim experience of trauma.
End Violence Against Women International developed this resource that walks through the neurobiological responses to trauma in an easy to understand, relatable way, including a section on victims’ survival reflexes.
Technical Assistance Providers on Trauma
The Dart Center for Journalism and Trauma provides this public service site with links to four national and international organizations that provide education regarding PTSD, articles, references, mini courses, 1–800 phone numbers, and email resources.
This organization serves those who suffer PTSD, those at risk for PTSD, and those who care for traumatized individuals, and develops and disseminates educational material.
This website provides resources to find support, forums, and resources for loved ones and family members. The community is comprised of mental health professionals, survivors of sexual abuse, and many who identify themselves as both professionals and survivors.
This organization assists publicly funded agencies, programs, and services in shifting to a more trauma-informed environment.
This website was developed by Jim Hopper, Ph.D. and offers information on the experiences, behaviors, and memories of sexual assault victims, including links to articles, resources, and trainings that are useful for all disciplines
This organization provides education and training on treating and managing traumatic stress, trauma-related advocacy, and information for the public on related issues.
The National Sexual Violence Resource Center provides a website of up-to-date trauma-informed tools.
Psychological Costs for Victims
SARTs need to know that every victim will have a different reaction to being sexually assaulted, with wide ranges of emotional responses. Victims may struggle with a perception that they are now "different" or not "normal." After the initial crisis, victims may feel especially vulnerable, isolated, anxious, out of control, depressed, or defensive. As victims begin to recover, they may experience a series of different emotions that may come and go with varying intensity. All these psychological reactions could affect daily functioning and well-being.
The psychological effects of sexual assault do not follow a predictable timeline and can last years or a lifetime. About 75 percent of victims of sexual assault experience at least one of the following: feelings of moderate to severe distress, significant problems with work or school, or significant problems with friends or family members. 
Emotional reactions are not uniform among victims and may include — 
- guilt, shame, or self-blame,
- fear or distrust,
- lack of control,
- disbelief, and
Psychological reactions may include — 
- difficulty concentrating,
- post-traumatic stress disorder (PTSD),
- substance use and abuse,
- low self-esteem, and
- eating disorders. 
The trauma of sexual assault can have specific effects on brain functioning and lead to various responses to the assault. Victims are at risk for mental health concerns stemming from PTSD.
More than 1 in 5 women (more than 22 percent) who experienced rape, stalking, or physical violence by an intimate partner report PTSD symptoms.  Of sexual assault victims, up to 51 percent meet the criteria for depression, up to 44 percent experience suicide ideation, and up to 40 percent experience generalized anxiety. 
For more information, see Understanding How Victims React to Trauma in the SART Toolkit.
Physical Costs for Victims
In treating or supporting a victim, it is important for SART members to understand that beyond any injuries they may incur, victims of sexual assault are likely to experience a number of physical reactions.
The body responds to trauma in many ways that cause both immediate and long-term changes. Some of the physical responses to victimization include — 
- increased heart rate,
- flight, fight, or freeze response,
- appetite changes,
- muscle tension,
- nausea, and
- changes in sexual desires.
Some of these physical reactions may occur during the assault or after the danger has passed, or they may reoccur later when the memory returns. Some of these symptoms can persist for extended periods of time after the assault. Additionally, physical injuries may not always be immediately apparent. 
Sexual assault has been linked to numerous adverse chronic health conditions, including — 
- chronic pain,
- gastrointestinal disorders,
- gynecological complications,
- migraines and frequent headaches,
- sexually transmitted infections,
- cervical cancer,
- asthma, and
- genital injuries.
Statistically, the physical aftermath and costs of sexual assault may include —
- physical trauma: Victims can be physically injured as a result of sexual assault, though only a small percentage are seriously physically injured. From 1992–2000, among victims of completed rape, 33 percent had sustained additional minor injuries, and 5 percent experienced additional serious injury. 
- pregnancy: It is difficult to estimate the number of sexual assaults that result in pregnancy. Studies estimate that between approximately five percent  and eight percent  of reported rapes result in pregnancy.
- sexually transmitted infections (STIs): Victims of sexual assault are at risk for contracting STIs.  This leads to health care costs associated with treatment, follow-up, and medication.
Economic Costs for Victims and Communities
SARTs should know that the economic costs of sexual assault are far-reaching and affect victims and their families, offenders, and the community. The victim may experience diminished employment, productivity, and earning potential. At the same time, the costs of health care, criminal justice processes, and social services increases.
Sexual assault and related trauma can disrupt a victim’s employment. For example, a victim may miss work time or experience decreased job performance, job loss, or an inability to work. Reduced earnings from employment disruption have long-term implications for a victim’s economic security and well-being. 
Victims also face health care costs and other expenses related to seeking services, such as mental health counseling, to counter the negative effects of their assaults. Some victims may be introduced to drugs or alcohol during an assault, or they may turn to drugs and alcohol as a coping mechanism following an assault. A strong correlation exists between sexual assault and subsequent substance abuse by victims.  This in turn can lead to additional costs, such as lost productivity at work, a need for treatment services, and possible increased involvement in the criminal justice system.
One study estimated that in the United States, rape and attempted rape have an economic impact 1.7 times the annual economic impact of cardiovascular disease, 3.9 times the annual economic impact of cancer, 3.7 times the economic impact of diabetes, and 19.6 times the annual economic impact of HIV/AIDS. 
Current research estimates the total lifetime cost of rape victimization is $122,461 per victim, or $3.1 trillion for all rape victims, not including costs to families and friends of the victim or perpetrator. The government pays an estimated $1 trillion, or 32 percent of the total costs of all rape victims through various programs.
The $3.1 trillion includes costs to the victim and the person who committed the offense, broken out into the following :
- 39 percent or $1.2 trillion in medical costs
- 52 percent or $1.6 trillion in lost work productivity of the victim and person who perpetrated,
- 8 percent or $234 billion in criminal justice activities
- 1 percent or $36 billion in other costs (victim property loss and damage)
Some states evaluate the cost of rape in their state. For example the California Coalition Against Sexual Assault developed a report, The Costs and Consequences of Sexual Assault in California.  Check to see if your state has calculated state-specific costs.
Two articles detail the devastating economic effect of sexual assault: What One Rape Cost Our Family and The Untold Financial Cost of Rape. Each article presents a case study of the estimated total costs of a sexual assault for a victim and their family. In one instance, the total cost — including lost wages, lost college tuition, and treatment for mental health consequences and addiction — was $245,574. 
Economic Impact Resources
Lifetime Economic Burden of Rape Among U.S. Adults (PDF, 11 pages)
This 2017 study by the Centers for Disease Control and Prevention (CDC) estimates the lifetime cost of rape in the U.S. CDC’s estimate includes criminal justice costs, property loss or damage, lost work productivity, and short- and long-term physical and mental health treatment.
Sexual Violence and The Workplace: Overview (4 pages, PDF)
This document, from the National Sexual Violence Resource Center (NSVRC), examines sexual assault and its effects on the workplace. It provides statistics and a brief overview of how sexual violence affects a victim’s employment and economic security.
These talking points were developed by the National Sexual Violence Resource Center around the CDC’s Lifetime Economic Burden of Rape Among U.S. Adults study.
The Cost of Rape in the United States (PDF, 1 page)
This CDC resource summarizes the costs of rape, in support of prevention efforts.
The Economic Burden of Rape: Infographic (PDF, 2 pages)
This infographic from the CDC summarizes the economic burden of rape.
xChange Podcast with Dr. Rebecca Loya (podcast, 7 minutes each)