Sexual Abuse

Sexual abuse refers to any non-consensual sexual contact or behaviour, including childhood sexual abuse, adult sexual assault, and ongoing sexual coercion in relationships. Survivors face elevated risk for trauma-related, mood, anxiety, eating, and substance use conditions, and effective trauma-focused treatment is widely available.

Overview

Sexual abuse encompasses any non-consensual sexual contact or behaviour. The term covers a wide range of experiences: childhood sexual abuse (sexual contact between adult and child, sexual contact between older and younger child with significant power difference, exposure to sexual content); adult sexual assault (rape, attempted rape, unwanted sexual contact); sexual coercion in relationships (sexual contact through pressure, threats, or absence of meaningful consent); institutional sexual abuse (in religious, educational, residential, healthcare, sport, or other institutional contexts); and technology-facilitated sexual abuse (image-based abuse, online sexual exploitation).

Sexual abuse is not a DSM-5-TR diagnosis. The DSM-5-TR addresses sexual abuse through related clinical contexts including PTSD when criteria are met (often the case), depression, anxiety disorders, dissociative disorders, eating disorders, substance use disorders, and personality-pattern presentations. The DSM-5-TR Z-codes include “Adult Sexual Abuse by Non-Spouse or Non-Partner” (T74.21), “Personal History of Sexual Abuse in Childhood” (Z62.810), and others.

Population data: approximately 1 in 4 girls and 1 in 6 boys experience sexual abuse before age 18 in Canada and similar Western countries. Adult sexual assault: approximately 30% of Canadian women experience non-consensual sexual contact in their lifetime. Rates are substantially higher in Indigenous women, women with disabilities, LGBTQ+ individuals, and certain occupational contexts (military, healthcare). Approximately 5-10% of men experience sexual abuse or assault, with substantial under-reporting.

The clinical impact of sexual abuse is substantial. Approximately 50-90% of sexual abuse survivors meet criteria for PTSD at some point; rates of major depressive disorder, anxiety disorders, eating disorders, substance use disorders, dissociative disorders, complex PTSD, and personality features are all substantially elevated. Suicide risk is meaningfully elevated. Long-term physical-health consequences include cardiovascular disease, chronic pain, gastrointestinal disorders, sexual-health concerns, and others.

Recovery is possible. Trauma-focused psychotherapies have substantial evidence supporting symptom reduction, post-traumatic growth, and restored capacity for relationships, work, and meaning. Many survivors achieve substantial recovery and meaningful life beyond the abuse experience. Effective Canadian-specific resources exist for both immediate crisis and long-term recovery.

Signs and symptoms

Intrusive memories or flashbacks — Recurrent, involuntary memories or sensory re-experiencing of abuse events; can be triggered by specific cues or seemingly random.
Avoidance — Avoidance of trauma-related thoughts, feelings, conversations, places, people, or activities. May extend to avoidance of sexual contact, intimacy, or specific contexts.
Negative cognitions and mood — Persistent negative beliefs about self, others, world; persistent shame, guilt, fear, anger; inability to experience positive emotions.
Hyperarousal — Hypervigilance, exaggerated startle, sleep disturbance, irritability, concentration difficulties, reckless or self-destructive behaviour.
Dissociation — Depersonalization, derealization, dissociative amnesia for parts of the abuse — particularly common in childhood sexual abuse with extended duration.
Sexual difficulties — Sexual dysfunction, avoidance of sexual contact, hypersexuality, painful sex, difficulty with sexual desire or arousal, complicated relationship with sexuality.
Difficulties with relationships and trust — Difficulty trusting others; pattern of relationships replaying abusive dynamics; intimacy difficulties; attachment difficulties.
Comorbid mental-health conditions — Depression, anxiety, eating disorders, substance use disorders, complex PTSD, borderline personality features, dissociative disorders all common.
Self-harm and suicidal ideation — Substantially elevated risk of self-harm, suicidal ideation, suicide attempts, and suicide completion.
Long-term physical-health consequences — Chronic pain, gastrointestinal disorders, gynecological symptoms, cardiovascular disease, autoimmune conditions — well-documented physical-health impact of sexual abuse.

Causes and risk factors

Risk factors for severity of post-abuse impact:

Abuse-specific factors: earlier age at onset, longer duration, severity, abuse by attachment figure or trusted adult (betrayal trauma), use of force or threat, multiple perpetrators, lack of support after disclosure, ongoing contact with perpetrator.

Vulnerability and protective factors: social support; validating disclosure responses; stable post-abuse environment; absence of additional adversities; access to mental-health support; cultural and community resources; meaning-making capacity.

Vulnerability to revictimization: survivors of childhood sexual abuse are at substantially elevated risk of adult sexual assault — approximately 2-3x baseline rates. Effective therapy can reduce this risk.

Comorbidity: PTSD (50-90%), depression (~50%), substance use disorders (~30-50%), eating disorders (substantial elevation), dissociative disorders (substantial in childhood-abuse cases), borderline personality features, suicide risk all substantially elevated.

Cultural and structural factors: stigma, victim-blaming, justice-system difficulties, cultural silence around sexual violence, immigration status, all affect survivor experience and outcomes.

Specific elevated-risk populations: Indigenous women, women with disabilities, LGBTQ+ individuals (particularly trans women), sex workers, individuals in institutional contexts (military, residential schools, sport, religious), incarcerated individuals.

Typical treatments

Trauma-focused, evidence-based psychotherapies are first-line. International guidelines (ISTSS, NICE, APA, VA/DoD) recommend:

Cognitive Processing Therapy (CPT): 12-session structured CBT focused on identifying and modifying “stuck points” (e.g., “it was my fault,” “I should have known better”). Strong evidence base for sexual abuse and assault.

Prolonged Exposure (PE): 8-15 session structured protocol involving repeated imaginal and in vivo exposure. Strong evidence base.

Eye Movement Desensitization and Reprocessing (EMDR): trauma-processing modality using bilateral stimulation. Strong evidence base; recommended by WHO and other guideline bodies.

Trauma-Focused CBT (TF-CBT): developed for children and adolescents who have experienced abuse. Strong evidence base; involves caregiver participation when appropriate.

Phase-oriented treatment for complex trauma: three-phase approach (stabilization, processing, integration) recommended by ISTSS for childhood sexual abuse with substantial dissociative or attachment features. Particularly important for extensive trauma history.

Sensorimotor Psychotherapy and Somatic Experiencing: body-oriented approaches that target trauma-related dysregulation through interoceptive awareness and structured movement. Often integrated with cognitive approaches.

Group therapy: survivor groups (general and population-specific — male survivors, LGBTQ+ survivors, Indigenous survivors, military sexual trauma) provide validation, normalization, and connection.

Sex therapy and intimacy work: for the sexual and relational consequences of abuse; integrated with trauma-focused work or as a separate phase.

Pharmacotherapy: SSRIs (paroxetine, sertraline FDA-approved for PTSD); prazosin for trauma-related nightmares; cautious use of benzodiazepines given dependence risk and evidence of poorer long-term outcomes.

Treatment of comorbid conditions: substance use, eating disorders, dissociative disorders, depression all commonly require integrated attention.

Crisis intervention and safety planning when suicide risk is present.

Population-specific approaches: Indigenous-led healing approaches integrating traditional knowledge; gay/bi/trans men sexual abuse–specific groups (MaleSurvivor); military sexual trauma–specific programs.

When to seek help

If you are in immediate danger now, contact emergency services: dial 911.

If you are a victim of recent sexual assault, you have several options that you do not have to choose between:

Contact a sexual assault crisis line (numbers below) for immediate emotional support and information.
Go to a hospital emergency department for medical care; many hospitals have Sexual Assault Nurse Examiner (SANE) programs with specialized care.
You can have a forensic exam (rape kit) performed even if you are unsure about reporting; evidence can be preserved while you decide.
You can report to police; you can also choose not to report.
Disclosure to a clinician is confidential — mandatory reporting laws in Canada apply primarily to ongoing child abuse, not to adult survivors of historical or recent abuse who are seeking care.

Free 24-hour Canadian sexual abuse and assault crisis support:

1-888-933-9007 — Ontario Coalition of Rape Crisis Centres (provides referrals to local centres).
Sexual Assault/Domestic Violence Treatment Centres at Ontario hospitals — most have 24/7 services.
1-866-863-0511 — Assaulted Women’s Helpline (Ontario; multilingual; 24/7).
1-844-762-8483 — SOS violence conjugale (Quebec, 24/7).
1-888-340-1234 — VictimLink BC (24/7, multilingual).
1-855-242-3310 — Hope for Wellness Helpline (Indigenous-led, 24/7).
1-866-925-4419 — Indian Residential Schools Crisis Line (24/7).
1-800-668-6868 — Kids Help Phone (under 20).
9-8-8 — Suicide Crisis Helpline, 24/7.
1-833-456-4566 — Talk Suicide Canada, 24/7.
211 — local social services.

For male survivors: 1in6 (1in6.org), MaleSurvivor (malesurvivor.org). For LGBTQ+ survivors: The 519 in Toronto and provincial LGBTQ+ services. For military sexual trauma: 1-800-883-6094 (Veterans Affairs Canada Assistance Service).

Professional therapy is indicated at any time after sexual abuse — recent or historical — when symptoms are interfering with your life or when you want support. It is never too late to begin healing work.

Frequently asked questions

How do I know if what happened was sexual abuse?

Sexual abuse includes any non-consensual sexual contact or behaviour. It includes childhood sexual abuse (sexual contact between adult and child, or sexual contact involving significant power imbalance between children); adult sexual assault; sexual contact obtained through coercion, pressure, or absence of meaningful consent; sexual contact while incapacitated by alcohol, drugs, or other factors. If you are unsure, a single confidential conversation with a sexual assault crisis line or trauma-informed clinician can help you sort through your experience.

Is it too late to get help if the abuse was years ago?

No. Trauma-focused treatments are effective regardless of how long ago the abuse occurred. Many survivors enter treatment 20, 30, or 40+ years after the events with substantial recovery. It is never too late.

Will I have to talk about all the details?

Trauma-focused therapy is paced according to your readiness. Stabilization comes before processing. Different modalities require different levels of detailed verbal disclosure: EMDR involves less verbal narrative than Prolonged Exposure or CPT. You retain control over what you share and when.

Will the therapist have to report what I tell them?

For adult survivors of sexual abuse, no. Mandatory reporting in Canada primarily applies to (1) imminent risk to yourself or others, and (2) ongoing or recent abuse of a child. A clinician can answer specific questions about reporting at the start of treatment.

Can men be sexually abused?

Yes. Approximately 1 in 6 boys and 5-10% of men experience sexual abuse or assault. Male sexual abuse is substantially under-recognized and under-reported, partly due to stigma and gendered assumptions. Specialized resources for male survivors exist (1in6, MaleSurvivor); general trauma-focused therapy is also effective.

Will I ever recover?

Yes. Many survivors achieve full symptom remission and report improved functioning, relationships, and sense of self after treatment. Recovery is not return to a pre-abuse self — it is the building of a new, more integrated self that includes the experience without being defined by it. Many survivors describe meaningful post-traumatic growth.

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). APA.
International Society for Traumatic Stress Studies. (2018). Posttraumatic Stress Disorder Prevention and Treatment Guidelines.
Statistics Canada. (2023). Family Violence in Canada: A Statistical Profile.
Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence. Basic Books.
van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.

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ShiftGrit Psychology & Counselling is professionally regulated, certified, and recognized by leading psychology and mental-health organizations across Alberta and Canada. These associations reflect our commitment to ethical practice, clinical standards, and evidence-informed therapy through Identity-Level Therapy and Reconditioning.

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ShiftGrit Clinical Editorial Team

The ShiftGrit Clinical Editorial Team combines the insight of registered psychologists, provisional psychologists, and trained writers to create accessible, evidence-informed therapy resources. All content is clinically reviewed by a Registered Psychologist.