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This article originally appeared on Health. For more stories like this, visit health.com.

HEALTH.COM/Amanda MacMillan
Dec 02, 2017 @ 8:00 am

When a sexual assault occurs—in the case of a rape, for example—it’s clear that the experience can affect the victim’s health, both immediately and in the long-term. But even instances of non-physical sexual harassment can have lasting effects on the people who are exposed to it, both emotionally and physically.

As recent news reflects, behaviors like unwanted sexual contact, coercion, lewd comments, and unprompted advances are common—in the workplace, in social situations, and even within trusted institutions like schools, sports teams, and churches. Here are some of the major ways harassment can take a toll on survivors’ health and well-being, and what they (and their loved ones) can do to heal.

Depression and anxiety

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

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

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

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Poor self-esteem and body image

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

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

Avoidance of places or activities

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

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

Disordered eating or loss of appetite

Problems with body image and self-esteem are often accompanied by disordered eating, says Courtois, and these can all be consequences of chronic sexual harassment. In addition, high levels of stress can lead to loss of appetite, which could then lead to weight loss, nutritional deficiencies, and related health risks.

Women may be the most stereotypical victims of these behaviors, but at least one study has also found a link between disordered eating and sexual harassment among men. In the 2013 Michigan State research, women reported more sexual harassment and greater overall concern about their weight and shape. But men who experienced high levels of sexual harassment were more likely than women to “purge” (vomit after eating) and take laxatives or diuretics in an attempt to control their weight.

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Out-of-control stress hormones

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

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

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

Homelessness

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

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

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Impaired heart health

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

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

Career problems

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

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

Sleep disturbances

“It’s very common for people who experience sexual harassment to experience insomnia,” says Courtois. “They play it over and over in their head, or it keeps coming back to them when they try to lie down at night.” When they do fall asleep, she says, traumatic experiences can cause nightmares.

This may be one way sexual harassment contributes to other physical health problems, says Dr. Sophy. “When you can’t sleep because of something so stressful, it can really wreak havoc on your body and put you at higher risk for all kinds of long-term problems,” he says.

Weight changes

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

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

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PTSD

Someone with a history of unwanted sexual experiences can suffer from post-traumatic stress disorder or PTSD—a condition that can include anxiety, panic attacks, crying spells, flashbacks, and visceral physical reactions, like headaches, stomach problems, and teeth grinding. “Their stress response is working overdrive, so they might overreact to something that wouldn't be threatening to someone without the same history,” says Courtois.

In an older article in the Journal of Counseling & Development, a woman described PTSD after sexual harassment as follows: “Memories of my intimate experiences with him continued to plague me. At unexpected moments, particularly when I was alone in my car, I would suddenly feel him there with me. His fingertips would draw my face toward his, and I would again feel his kiss, catching me unaware and sending a jolt of anxiety through my body.”

How survivors can heal

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

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

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