“Only yes means yes” is more than a slogan, and discussions on what that really entails are more urgent now than ever. In a world after #MeToo, it is tempting to believe that the consent conversation is over, but it is not. Only last year, 1 in 3 European women reported having experienced sexual assault, underlining how essential it remains to keep speaking about consent (European Union Agency for Fundamental Rights et al., 2024).
For many survivors, the impact does not end with the assault itself. Despite no clear medical cause, diffuse bodily symptoms can continue to occur years after the event. Research has consistently linked sexual assault with somatic syndromes such as persistent widespread pain (Ulirsch et al., 2014), and traumatic activation of the stress system can alter neurosensory processing in lasting ways (Short et al., 2022).
Building on this evidence, a new landmark study from the Danish DanFunD cohort directly tested whether sexual assault increases the risk of developing functional somatic disorder (FSD) – an umbrella diagnosis encompassing Functional Symptomatic Syndromes (FSSs) like chronic widespread pain (CWP), irritable bowel syndrome (IBS), and chronic fatigue, that cause substantial disability without identifiable organic causes (Burton et al., 2020; Jacobsen et al., 2025).
Sexual assault has lasting effects, and this study asks whether those effects include a higher risk of long-term functional somatic disorders.
Methods
The authors used data from a large Danish cohort study to investigate the lifetime history of sexual assault at baseline (n = 7493) and see how it influences the risk for functional somatic disorder (FSD) in a 5-year follow-up (n = 4288). FSD symptoms were clustered into cardiopulmonary, gastrointestinal, musculoskeletal and fatigue. They also differentiated between single-organ and multiorgan FSD. Ten covariates were selected, including biological sex, prior somatic diseases, perceived stress.
Two main questions were assessed:
- Question 1: Does sexual assault raise your risk for functional somatic disorder?
- Question 2: Do survivors of sexual assault experience a higher frequency and/or more severe incident somatic symptoms than individuals not exposed to sexual assault (i.e., more symptoms, and/or worse ones)?
Results
Question 1: Does sexual assault raise your risk for functional somatic disorder?
The short answer is yes.
- Unadjusted analyses showed clear links between reporting sexual assault (SA) at baseline and the development of FSD over the 5-year follow-up.
- Adjusting for covariates only strengthened the case, showing that having experienced SA leads to an increased risk of developing FSD, FSS, as well as single-organ FSD and CWP.
- Most intriguing is that they found a 6-fold increased risk (RR 6.47) of developing multiorgan FSD. So, not only does SA contribute to developing FSD and related disorders, but it also seems to raise one’s risk by quite a large margin.
Question 2: Do sexual assault survivors experience more and/or worse symptoms?
Again, the answer appears to be yes.
- Survivors of sexual assault (SA) reported a higher frequency of symptoms across all four bodily clusters: general/fatigue, gastrointestinal, musculoskeletal, and cardiopulmonary.
- Compared to those without assault exposure, survivors of SA also had an up to 20% higher risk of developing pain in their joints, gastrointestinal symptoms like abdominal pain and bloating, and overwhelming fatigue. These symptoms were also generally reported as more severe.
The authors were also interested in the question: does emotional distress make these physical symptoms worse?
- Interaction analyses did not support this.
- Baseline emotional distress didn’t moderate or amplify the SA-FSD connection – meaning, the physical risks from trauma did not seem to be exacerbated by emotional state.
Sexual assault is associated with long-term, often high severity physical symptom patterns that cannot be fully accounted for by emotional distress alone.
Conclusions
Overall, this study delivers a clear message: sexual assault significantly raises the risk of functional somatic disorder (FSD) – spanning multiple bodily systems and increasing the overall burden of symptoms. In the authors words:
The results suggest that the consequences of sexual assault extend across multiple organ systems, reflecting multiorgan involvement rather than confinement to 1 organ system.
While FSD symptoms are also a concern in the general population, this study highlighted that burden (along with the initial risk of development) is much higher in people who have been sexual assaulted. These conclusions stand in a long line of evidence linking traumatic experiences – like sexual assault – to the later development of chronic pain (Bussières et al., 2023).
Traumatic experiences such as sexual assault appear to be linked with broader, multisystem functional symptoms later in life.
Strengths and limitations
Strengths
This study tackles a critical, timely question with a population-based Danish cohort that cuts down on selection bias by spanning sex, age, and sociodemographics. The outcome – functional somatic disorder (FSD) – is defined using the Bodily Distress Syndrome (BDS) framework (Petersen et al., 2020), with subtypes such as chronic widespread pain (CWP) and irritable bowel syndrome (IBS) pooled to enhance statistical power (Petersen et al., 2020). The self-reports hold up well, validated by clinician interviews in a subset. Comprehensive confounder adjustments (e.g., sex, prior somatic diseases, perceived stress), sensitivity analyses, sex-stratified results, and a substantial sample size further increase the robustness of the findings and strengthen the impression of reliability.
Weaknesses
The sample’s restriction to Danish citizens fluent in Danish limits generalisability and diversity. The sexual assault (SA) assessment relied on only two items from the Cumulative Lifetime Adversity Measure (Carstensen et al., 2020), potentially overlooking nuanced experiences beyond their focus on forced touch or sex. Emotional distress, a variable that may play an important role in the relationship of SA and FSD, was measured solely at baseline, neglecting that it may be of fluctuating nature. The low 5-year follow-up response rate may overestimate FSD incidence, while the fixed timeline ignores SA timing, frequency and severity. BDS’s binary categorization (“bothered” vs not) could under-detect milder cases. The small male subsample precludes robust sex-specific insights, and symptom clustering rather than individual analysis reflects power constraints of the study. Notably, post-SA emotional responses were unmeasured, introducing potential bias.
Overall, the evidence robustly links sexual assault to functional somatic disorder, but methodological gaps in diversity, measurement nuance, and longitudinal depth warrant replication in broader cohorts.
This study benefits from robust design and statistical power, but is limited by measurements that lacked nuance and poor sample diversity.
Implications for practice
Coming back to where we started: Awareness and understanding of sexual assault is still urgently needed. This study makes painfully clear that the consequences are not only psychological, but can also show up as a heavy, long‑term physical burdens.
On the research side, the findings underline the need for larger, more diverse samples, including more men, and more refined methods of measurement. Future work should unpack different subtypes of functional somatic disorder and functional symptomatic syndromes, and explore their overlap with related diagnoses such as somatic symptom disorder. Also, more work should be put into revealing the molecular basis of these phenomena. Understanding the biological pathways underlying the emergence of disorders following sexual assault is key to improving care and exploring possible protective factors.
On the action side, the message is equally clear: it is not enough to treat the aftermath. There is an urgent need to tackle the root causes of sexual assault in the first place and to invest seriously in prevention, protection, and trauma‑informed care. Victims should not be left alone and be gaslit into believing it is “all in their heads”.
As addressed in the beginning, 1 in 3 women has experienced some kind of sexual assault. Even if it’s not you, it’s likely someone close to you. Raising awareness and fostering empathy is key to shining a light on this hidden epidemic – and our work to end it.
One in three women experiences sexual assault. Long-term physical and psychological impacts of sexual assault demand better research, prevention, and support for survivors.
Statement of interests
Jennifer Reif wrote the first draft of this blog and has no competing interests to declare. Perplexity.ai was used for language refinement and text flow improvement.
Editor
Edited by Éimear Foley. AI tools assisted with language refinement and formatting during the editorial phase.
Links
Primary paper
Jacobsen, Sofie A., Petersen, Marie W., Wellnitz, Kaare B., Ørnbøl, Eva, Dantoft, Thomas M., Jørgensen, Torben, McLean, Samuel A., Frostholm, Lisbeth, & Carstensen, Tina B. W. (2025). Functional Somatic Disorders in Individuals With a History of Sexual Assault. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2025.3251
Other references
Burton, C., Fink, P., Henningsen, P., Löwe, B., Rief, W., & on behalf of the EURONET-SOMA Group. (2020). Functional somatic disorders: Discussion paper for a new common classification for research and clinical use. BMC Medicine, 18(1), 34. https://doi.org/10.1186/s12916-020-1505-4
Bussières, A., Hancock, M. J., Elklit, A., Ferreira, M. L., Ferreira, P. H., Stone, L. S., Wideman, T. H., Boruff, J. T., Al Zoubi, F., Chaudhry, F., Tolentino, R., & Hartvigsen, J. (2023). Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: A stystematic review and meta-analysis. European Journal of Psychotraumatology, 14(2), 2284025. https://doi.org/10.1080/20008066.2023.2284025
Carstensen, T. B. W., Ørnbøl, E., Fink, P., Jørgensen, T., Dantoft, T. M., Madsen, A. L., Buhmann, C. C. B., Eplov, L. F., & Frostholm, L. (2020). Adverse life events in the general population—A validation of the cumulative lifetime adversity measure. European Journal of Psychotraumatology, 11(1), 1717824. https://doi.org/10.1080/20008198.2020.1717824
European Union Agency for Fundamental Rights, European Institute for Gender Equality, & European Commission (Hrsg.). (2024). EU gender-based violence survey: Key results: experiences of women in the 27 EU Member States. Publications Office. https://doi.org/10.2811/6270086
Petersen, M. W., Schröder, A., Jørgensen, T., Ørnbøl, E., Dantoft, T. M., Eliasen, M., Thuesen, B. H., & Fink, P. (2020). The unifying diagnostic construct of bodily distress syndrome (BDS) was confirmed in the general population. Journal of Psychosomatic Research, 128, 109868. https://doi.org/10.1016/j.jpsychores.2019.109868
Short, N. A., Tungate, A. S., Bollen, K. A., Sullivan, J., D’Anza, T., Lechner, M., Bell, K., Black, J., Buchanan, J., Reese, R., Ho, J. D., Reed, G. D., Platt, M. A., Riviello, R. J., Rossi, C. H., Martin, S. L., Liberzon, I., Rauch, S. A. M., Kessler, R. C., … McLean, S. A. (2022). Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain. Pain, 163(1), e121–e128. https://doi.org/10.1097/j.pain.0000000000002329
Ulirsch, J. c., Ballina, L. e., Soward, A. c., Rossi, C., Hauda, W., Holbrook, D., Wheeler, R., Foley, K. a., Batts, J., Collette, R., Goodman, E., & McLean, S. a. (2014). Pain and somatic symptoms are sequelae of sexual assault: Results of a prospective longitudinal study. European Journal of Pain, 18(4), 559–566. https://doi.org/10.1002/j.1532-2149.2013.00395.x
