Young adults frequently enter treatment with shame-based secrets — and having been sexually or physically abused is very likely the No. 1 secret. Sexual abuse can include unwanted touching, molestation, or rape. Physical abuse can range from pushing, shoving, kicking, and pinching, to hitting, punching, and worse; and the offenders are usually family members, whether it’s a sibling, parent, or stepparent.

Sexual abuse can also happen at the hands of a family member, making it incest, or the perpetrator can be a family friend, someone in the neighborhood, at school, or a complete stranger. It can be covert with no touch involved, such as sexual shaming, exposing a child to pornography, or sexualized joking and innuendo. Molestation, unwanted touching, and rape (by a family member, stranger, acquaintance, or date) are all forms of overt sexual abuse. As teens and young adults begin experimenting with drugs and alcohol, there is greater risk of sexual assault. Today, young women need to be aware of the risk of being drugged without their knowledge, often for the purpose of sexual assault by one or multiple perpetrators.

You don’t even need to experience abuse firsthand to be affected. In a family where there is physical abuse, witnessing that abuse can be just as harmful as being the victim. This phenomenon, called the “witness factor,” recognizes that those who witness abuse often struggle with the same issues as those who are the recipient of abuse. This leads to an overwhelming sense of powerlessness and immobilization that and needs to be addressed in order to find healing.