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Ben Barrett-Forrest/The Globe and Mail

When women who have been raped come to Amanda Dale's trauma recovery group, many don't know what damage the attack may be wreaking.

"They just know they're in trouble," says Dale, executive director of Toronto's Barbra Schlifer Clinic, which helps women facing violence.

Some survivors feel deep shame, others anger and debilitating grief. Some will suffer panic attacks, startling at the slightest sound. Others, overwhelmed by humiliation and a sense of being devalued, will self-destruct, drinking or abusing drugs to cope. Many will struggle with trust issues, developing serious trouble in their intimate relationships.

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Even as we encourage women to come forward and tell their stories, the long shadow of sexual assault is something not often discussed. Research shows that the effects of the trauma endure for a long time; front-line services, however, are lacking in this country.

The immense personal costs are hinted at in the pivotal New York magazine profile, by Noreen Malone and Amanda Demme, of 35 women who allege comedian Bill Cosby drugged and sexually assaulted them over four decades. The women spoke of pained self-recrimination, shattered self-esteem, an inability to form real relationships with partners, depression and substance abuse. One woman described the after-effects as a "secret tumour."

"The group of women Cosby allegedly assaulted functions almost as a longitudinal study – both for how an individual woman, on her own, deals with such trauma over the decades and for how the culture at large has grappled with rape over the same time period," the journalists wrote.

Trauma for victims of sexual assault is individual and unpredictable, the symptoms appearing in pulses over the years. Directly after an attack, there is often shock and visceral fear. Particularly when a victim knows the rapist, there can be guilt and self-doubt. Another layer to contend with is the physical trauma, which can include injuries, sexually transmitted diseases and pregnancy. The emotional damage can take a longer time to emerge and can include anxiety, long-term insomnia, a sense of alienation and thoughts of suicide. While some women get hyper-vigilant, others start taking risks. Especially if women experience victim-blaming, the assault can leave them feeling worthless and turning to harmful coping strategies.

"It impacts your everyday living and your intimate relationships," Karyn Freedman, author of the recent book One Hour in Paris: A True Story of Rape and Recovery, says.

"As a society, we'd prefer it to be not that big of a deal: one or two conversations with someone and you'll be better. What the New York magazine piece showed us is that the effects are lifelong," Freedman, now an associate professor of philosophy at the University of Guelph, said.

A 2015 meta-analysis found that trauma causes neural changes and has a measurable and enduring effect on brain function, including regions involved in "emotional regulation." For victims of sexual violence, trauma can live in the body as a chronic condition.

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"When you've had your trust violated, at a physiological level your body doesn't know when it's safe any more," Dale says. "You can wind up navigating your entire life from a position of high alert. That translates into a form of constant vigilance that intrudes into your sleep time and your sexuality so that you cannot rest or enjoy your body."

Without support, the aftershocks of sexual violence can be profound: "It remains something that you have a relationship to for the rest of your life," Dale says. "But if you don't have assistance … the experience of the violation can become part of one's identity, or in some of the worst cases, all of one's identity."

The long-term effects of rape are particularly pronounced when victims are shunned. Research suggests that the reception a woman gets the first time she discloses her attack can shape her experience of trauma. With supportive reception, survivors' psychological distress can lessen, making them less susceptible to re-victimization. But women who are dismissed when they speak up for the first time often do not talk about it again, a silence that can be extremely detrimental.

"When your experience is undermined, when no one takes you seriously and when you can't talk about it, you don't have a chance to repair the damage that's done," Freedman, who didn't tell anyone about her rape for a decade, said. "I lived in a world of terrible shame and I was emotionally crippled by the experience. I abused alcohol more than I ought to have. That's a coping mechanism that's sometimes easier than facing the reality of what's happened to you – especially in a culture that refuses to face it alongside with you."

So why is it easy for society to recognize trauma in soldiers and victims of violent crimes such as robberies but harder for some to extend that empathy to victims of sexual violence?

Diane Hill, who has worked as a counsellor for assaulted women, says people react with discomfort to the sexual elements of the attack. "It's not a romantic episode gone awry. It needs to be taken out of that category and put into the category of violent crime," says Hill, senior director of marketing and communications at the Canadian Women's Foundation, which raises funds for sexual assault counselling centres, women's shelters and violence prevention programs for youth.

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"I think we're suffering the Victorian hangover," Dale says, "of still being focused on the fact that the violence is sexual in nature. That somehow changes our reception of it as a crime."

As public education improves, victim blaming gets called out online and women are increasingly encouraged to come forward, Freedman hopes we'll see the "longevity of trauma" shrinking. But while experts are glad publicized allegations such as those against Cosby and Jian Ghomeshi (who faces five charges of sex assault and one charge of choking) are moving women to tell their own stories, they stress that front-line services need bolstering. According to figures from the Canadian Women's Foundation, sexual-assault centres saw spikes in calls after the headlines but had trouble meeting the demand thanks to flat-lined funding and wait times of more than a year for in-person counselling.

"I can't help but think about all the women who are finally able to talk about what happened to them. They need support to address these long-festering issues that they've had to put a lid on because they were not believed or because the support wasn't there," Hill said.

"It's irresponsible to raise awareness without raising the capacity to receive these stories," Dale says. "We got 30 calls last week. We don't want to keep those women waiting for a response. They're ready. They're calling."

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The costs of sexual violence

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The trauma of sexual violence can impact victims for a lifetime, affecting their health, education and employment. With 460,000 people reporting a sexual assault in one year alone in Canada, the annual costs are staggering: $1.9-billion when you factor in the physical, emotional and financial toll on victims and the costs for health and social services, police, courts and employers.

Counselling and legal advice can help survivors regain control but experts are agitating for more investment in violence prevention programs for youth that model healthy relationships from the get-go – all to temper the devastating personal costs for survivors and the collective costs for society.

The cost to survivors:

$75.9-million: mental-health services

$2.6-million: health-care costs

$23.9-million: productivity losses

The cost to society:

$161.3-million: police

$21.3-million: courts

$172.4-million: social services

$1.3-million: employers

Source: Canadian Centre for Policy Alternatives; Canadian Women's Foundation; Statistics Canada

Editor's note: The 35 women included in the New York magazine article mentioned in this story were allegedly assaulted over four decades. Incorrect information appeared in the original version of this article.

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