by Cassandra Voth, Michelle Schrag, and Dwight Krehbiel*

An Introductory Note

Sexual violence is a tool of dominance, and as such, it permeates every aspect of our inequitable society. There is no one disciplinary approach that is the silver bullet for understanding it, or for solving it. At Into Account, our expertise is concentrated in the humanities, specifically in American Studies, gender studies, and theology.  That’s part of why I’m so pleased to introduce this piece by two students and a retired professor from the psychology department at Bethel College in North Newton, Kansas, which is both my undergraduate alma mater and a recent focus of survivor-led activism from students and Into Account clients. In this summary, Cassandra, Michelle, and Dwight give us a research-based overview of the health impacts of sexual violence, drawing heavily on recent studies in medicine, psychology, and public health.

Those of us reading this as survivors may well recognize parts of ourselves in the data cited here. If that’s you, read this with care for yourself. You are more than a statistic. If you’re reading as an institutional leader, clergy member, physician, teacher, or anyone else with power over the lives of vulnerable people, my hope is that you’ll read this with humility, curiosity, and determination to use your power for good. As our authors write, “Sexual harassment cannot be prevented by simply seeking to comply with federal regulations. Preventing sexual harassment is everyone’s responsibility.”

(For academic institutional leaders seeking guidance, please check out the summary recommendations from the recent report of the National Academies of Science, Engineering, and Medicine. They provide an excellent beginning for moving away from a legal compliance-based approach to sexual harassment and moving towards evidence-based measures for prevention and accountability.)

–Stephanie Krehbiel, PhD, Executive Director, Into Account

Sexual Harassment Harms Health

Sexual harassment has received a great deal of attention in the news media in recent  years, often centered on the veracity of allegations against well known entertainment, political, or religious figures. The focus on whether such allegations are shown to be true leads to endless disputes about what counts as evidence, considering that there are often only two observers of the events in question, observers who have sharply contrasting interests in the outcome. While there appears to be an emerging consensus that the accounts of victims must always be taken seriously, the interests of perpetrators are still frequently prioritized (e.g., as in the recent Senate confirmation hearings of Brett Kavanaugh).

Thus, when the evidence regarding occurrence of harassment is perceived to be ambiguous (a high proportion of cases), the tendency to minimize the severity of the events for the lives of victims remains very strong. In this post we argue that one may be better able to understand the severe consequences of sexual harassment for victims by shifting our focus to assessing the health impact of the harassment. Indeed, the extensive health impact of widespread sexual harassment is emerging as a major public health problem.

Clarity will require that key terms be used in a consistent way, preferably in keeping with common usage in the scholarly literature about sexual harassment. The definitions that we employ are those of an extensive recent report (National Academies of Science, Engineering, and Medicine (NASEM), 2018**), which treats “sexual harassment” as an umbrella term comprised of three behavioral categories — gender harassment, unwanted sexual attention, and sexual coercion. The latter two of these categories may include sexual assault, and, hence, individual incidents for these categories may be more severe than for gender harassment. However, gender harassment (e.g., behaviors that are hostile, objectifying, exclusionary, etc.) is far more frequent than the other two categories. We should also note that while the effects of sexual harassment are experienced by the target of the harassment (direct effects), others may also experience the general climate of harassment in a particular environment (ambient effects).

Although gender harassment is more common than unwanted sexual attention or sexual coercion, physically violent forms of harassment are far from rare. A recent survey indicates that about 1 in 6 men and 1 in 3 women experience some form of contact sexual violence during their lifetime (Black et al., 2011). The frequency of such violence is even greater for women who are 18-24 years of age — three times more likely than the general population of women for college students and four times more likely for those in this age range who do not attend college. Moreover, women in college experience sexual violence at a rate of 23.1 percent compared to a rate of 5.4 percent for college men (Campus Sexual Violence: Statistics, 2018).

In spite of the high frequency of sexual harassment, the tendency to minimize its consequences is also very widespread. Proposing solutions to this dismissive tendency is beyond the scope of this article, with one exception: documentation of its damaging consequences. Education, training, and advocacy that are designed with the goal of preventing sexual harassment should be informed by knowledge of the existing research on its effects. To that end, the remainder of this post will focus on the health consequences of these forms of sexual harassment.

Mental health impact

The negative consequences of sexual harassment for the mental health of victims have been documented in numerous studies over more than the past two decades. Psychological distress arising from harassment has been found to take a variety of forms including depression, stress and anxiety, disordered eating, lower self-esteem, anger, disgust, increased use of prescription drugs and alcohol, and generally impaired psychological well-being. This distress sometimes results in a severe psychological disorder, notably major depressive disorder (1 in 5 cases) or post-traumatic stress disorder (PTSD, 1 in 10 cases).

More frequent incidents of harassment are shown to produce more severe effects. Related to this pattern is the finding that gender harassment produces mental health effects that are similarly severe as those of more physically violent forms of abuse, demonstrating the negative consequences of all these forms of sexual harassment. These findings imply that focusing attention on the impact of more severe forms of sexual abuse, while justified by their grave consequences for victims, very likely underestimates the overall harm to health and productivity produced by sexual harassment.

Often accompanying and intertwined with these reported symptoms and disorders are major disruptions in the work and educational lives of victims. Decreased job satisfaction, absenteeism, and withdrawal from the employing organization are frequent. More extreme outcomes occur as well — e.g., resignation from a particular job or even leaving a profession altogether.

Educational outcomes are also severely affected by sexual harassment. Somewhat similar kinds of disruptions have been reported from high school through graduate study. Absence from classes, dropping classes, lower grades, shifting to a different academic interest, and dropping out of school are among the observed consequences of sexual harassment. The psychological consequences described earlier are likely contributors to these educational disruptions. The problems appear to be severe at all educational levels. In fact, a recent study at one major university has found even more evidence of sexual harassment, at least that perpetrated by faculty and staff, for graduate and medical students than for undergraduates.

There are many reasons to believe that the consequences of sexual harassment extend beyond its effects on mental health. Furthermore, trivializing mental health, dismissing mental illness as evidence of weakness, and stigmatizing those who develop psychological disorders remain common in our culture. These patterns were evident in the Kavanaugh confirmation in 2018, especially in the behavior of the current U.S. president.

Physical health impact

The strong existing literature linking psychological stress to a variety of physical health outcomes, especially cardiovascular disease and human immunodeficiency virus (HIV) infection (Cohen, Janicki-Deverts, & Miller, 2007), suggests similar consequences from the stress caused by sexual harassment. Indeed, an experiment on the effects of sexist comments by a male co-worker (Schneider, Tomaka, & Palacios, 2001) demonstrated cardiac and vascular responses similar to those observed in threat situations — responses known to be predictive of coronary heart disease and depressed immune function. The high frequency of this form of sexual harassment heightens these concerns. Decreased self-rated health and somatic complaints such as headaches, sleep problems, and exhaustion are among other findings indicating physical health impacts. These findings are consistent with the literature demonstrating psychological effects on health, indicating that both mental health and physical health impacts of sexual harassment contribute to negative effects on overall health.

Photo by Dan Meyers on Unsplash

This perspective can be further illustrated by studies of sexual trauma effects on the brain (Shors & Millon, 2016). The powerful influence of emotional events on memory are extensively documented in the psychological literature. The most common effect of emotional arousal is to strengthen memories of the main events that occur at the time of the emotion. However, when the emotions are negative, memory for the details of the surrounding context may actually be impaired (Rimmele, Davachi, Petrov, Dougal, & Phelps, 2011). These memory modifications involve physical changes in the brain, such as the formation of new brain cells as well as new connections between those cells. Thus, sexual trauma likely produces physical changes in the brain that underlie the profound, inescapable memories of the trauma as well as accompanying confusion about details.

Another possible outcome of sexual abuse is early cessation of breastfeeding. An intensive study of six mothers who had been victims of childhoood sexual abuse found that the experience of breastfeeding acted as a trigger for remembering or reexperiencing the abuse (Wood & Van Esterik, 2010). A recent study in Norway of 53,394 mothers showed that among abused mothers there was an increased likelihood (30-40%) that breastfeeding will cease by four months after giving birth (Sorbo, Lukasse, Brantsaetter, & Grimstad, 2015). Thus, sexual abuse may result in preventing the health benefits of breastfeeding for the abused mother’s children.

Sexual abuse has also been associated with pelvic floor disorders. These disorders are a group of conditions that affect the pelvic floor, including the muscles, ligaments, and connective tissue in the lowest part of the pelvis. The pelvic floor supports the internal organs within the pelvis, including the bowel, bladder, uterus, vagina, and rectum. Although research on the role of sexual abuse in these disorders remains somewhat unclear, multiple studies have found associations between a history of sexual abuse and chronic pelvic pain (e.g., Cichowski, Dunivan, Komesu, & Rogers, 2013). Here again there are complex negative consequences of sexual abuse for overall health.

Implications

Much is said and written about the difficulty of deciding whom to believe in conflicting accounts regarding incidents of sexual harassment, with a great deal of attention given to the possibility of false accusations. This concern seems to give little consideration to the extreme power imbalance between harassment perpetrators and victims and, hence, the severe disincentives for victims to report harassment.

Dr. Christine Blasey Ford, testifying before the U.S. Senate

In addition to that potent factor, we simply offer the evidence for extensive impact of harassment on a woman’s health. Depression, PTSD, numerous stress-related impacts, sleep disturbance, headaches, educational and professional disruptions, interference with breast-feeding, chronic pelvic pain — these are just a partial list of the health-related impacts of sexual harassment. If women are just faking their accusations, why is their health so drastically impaired in the wake of the alleged incidents? 

In addition, there is much evidence to indicate that these effects are even worse for women of color,  women with disabilities, and for LGBTQ persons. The frequency of sexual harassment and the severity of its effects constitute a major public health problem for all of humankind.

Preventing sexual harassment is an important matter and needs to be more directly and vigorously addressed on both an institutional and a societal level. All categories of sexual harassment have negative, long-term, pervasive health outcomes. The effects of sexual harassment on women’s health are disruptive to the education, careers, and social lives of women, and should be viewed and treated with great seriousness. Women are clearly at a greater risk for sexual harassment than are men, and women and gender non-conforming people with multiple marginalities are likely at an even greater risk.

Because women continue to have less systemic power than men, it is vital to have strong leadership and cooperation of individuals of all gender identities to prevent sexual harassment. Sexual harassment cannot be prevented by simply seeking to comply with federal regulations. Preventing sexual harassment is everyone’s responsibility.

We have a long way to go — chin up and charge the mountain!

*About the Authors: Cassandra Voth holds a B.A. in Psychology, and Michelle Schrag holds a B.A. in Biology. Both graduated from Bethel College in May 2019. Dwight Krehbiel, PhD, is Retired Professor of Psychology and Pre-Health Professions Advisor at Bethel College.

**The findings discussed in this post summarize contents of the NASEM report except where additional sources are cited.

Acknowledgment: The authors wish to thank Dr. Rachel Messer for advice on this post.

References

Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Campus Sexual Violence: Statistics (2018). Rape, Abuse & Incest National Network. Retrieved from https://www.rainn.org/statistics/campus-sexual-violence

Cichowski, S. B., Dunivan, G. C., Komesu, Y. M., & Rogers, R. G. (2013). Sexual abuse history and pelvic floor disorders in women. Southern Medical Journal, 106(12), 675–678. https://doi.org/10.1097/SMJ.0000000000000029

Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. JAMA, 298(14), 1685. https://doi.org/10.1001/jama.298.14.1685

National Academies of Sciences, Engineering, and Medicine (2018). Sexual harassment of women: climate, culture, and consequences in academic sciences, engineering, and medicine. Washington, DC: The National Academies Press. doi: https:// doi.org/10.17226/24994.

Rimmele, U., Davachi, L., Petrov, R., Dougal, S., & Phelps, E. A. (2011). Emotion enhances the subjective feeling of remembering, despite lower accuracy for contextual details. Emotion, 11(3), 553.

Schneider, K. T., Tomaka, J., and Palacios, R. (2001). Women’s cognitive, affective, and physiological reactions to a male coworker’s sexist behavior. Journal of Applied Social Psychology, 31(10), 1995–2018. https://doi.org/10.1111/j.1559-1816.2001.tb00161.x.

Shors, T. J., & Millon, E. M. (2016). Sexual trauma and the female brain. Frontiers in Neuroendocrinology, 41, 87–98. https://doi.org/10.1016/j.yfrne.2016.04.001

Sørbø, M. F., Lukasse, M., Brantsæter, A.-L., & Grimstad, H. (2015). Past and recent abuse is associated with early cessation of breast feeding: Results from a large prospective cohort in Norway. BMJ Open, 5(12), e009240. https://doi.org/10.1136/bmjopen-2015-009240

Wood, K., & Van Esterik, P. (2010). Infant feeding experiences of women who were sexually abused in childhood. Canadian Family Physician, 56(4), e136–e141.

Helpful Links

• Videos of presentations by contributors to NASEM report
• The iceberg image of sexual harassment (shows relationship among the three major categories of harassment)