It steals stability. It upends victims' lives in the walking dead days that follow an attack, and sometimes forever.
While the physical and emotional toll is enormous, so, too, are the financial costs. CNN spoke with survivors who, because of their attacks, lost days from work, or found themselves unable to work again.
Some described how their rape led them to drop out of college, setting them back years in pursuing their education and delaying their entry into the workforce.
One woman said her rape untethered her entirely. Beset by depression and a sense of worthlessness, she accepted low-paying jobs that made it hard to afford the counseling she desperately needed.
Some survivors talked about the costs incurred because they had to move; they no longer felt safe living in the cities or towns or apartments where they were assaulted.
Some described getting help from their family members, who felt a financial impact as well. Others were left on their own.
Many who spoke to CNN stressed how crucial it is for advocates and others in the justice system to inform victims of compensation funds in each state. Victims can apply for reimbursement for counseling, medical costs, lost wages and other expenses. The funds are supported chiefly by penalties collected from convicted criminals of all kinds.
The experiences of two survivors and their families are detailed below. They spoke with the hope that their stories would demonstrate this little-discussed truth: that the trauma of rape can be compounded by financial costs both big and small.
Madeleine's case: Eight years, and the cost of support
Madeleine grew up listening to her parents tell stories about the good old days at Kansas State University. So she was thrilled when she got accepted there, and began her freshman year in 2007.
"I was an outgoing person," she remembers. "I thought maybe one day I could be a broadcast journalist."
On November 29, as she crossed campus with friends, she noticed a guy who seemed to be lingering behind them.
When Madeleine split off from her friends, the man followed her into her all-girls dormitory, prosecutors would later say, and raped her in her room.
The assailant was Laron James, a Kansas State student, according to Riley County District Attorney Barry Wilkerson. James' DNA matched DNA recovered from Madeleine's body during a forensic exam after her rape, Wilkerson told CNN.
When James was arrested months later in Texas, the prosecutor said, he was charged with rape.
But Wilkerson said he faced a significant obstacle the night before James was scheduled to stand trial: Madeleine's family said she was too traumatized to testify, too afraid to face her attacker.
As is the reality sometimes in cases that allege rape, Wilkerson suspected it was unlikely he'd win a conviction without the victim's testimony. Ultimately the trial didn't happen. No longer a student by then, James pleaded no contest to "attempted rape without consent." He was sentenced to four and a half years in prison.
He is now free, a registered sex offender living in Manhattan, Kansas, where Kansas State is located.
Eight years after her assault, Madeleine is married and living in another state. She spoke to CNN on the condition that she would be identified only by her first name.
She and her family struggle every day, she said, with the aftershocks of her assault.
After the rape, Madeleine says, she remained frozen in fear in her room for hours. When a girl who lived in an adjacent room knocked on her door the next morning, Madeleine told her what had happened.
The girl summoned a residential adviser, who drove Madeleine to a hospital where she was interviewed by campus police and underwent a forensic examination meant to recover the perpetrator's DNA.
Before she left the hospital, Madeleine said a victim's advocate handed her a packet of information and walked away.
"No one asked if I was OK. (The advocate) came in, introduced herself and flung a package at me. I never saw her again," Madeleine recalled.
The resident adviser had stayed at the hospital and drove Madeleine back to her dormitory.
"I was devastated," she said. "I felt kind of dumped. I felt disgusting. I was completely broken."
Not knowing what else to do, she walked to the communal shower and, for three hours, crouched on the tile and wept.
She said no one from the university called her, or checked on her. "I had to make decisions about what to do," she said. "I was alone."
She knew what she had to do next, but could hardly stand the thought. With a friend by her side, she called home and reached her mother.
"I said, 'Mom I have something to tell you,'" Madeleine remembers.
She couldn't say the words, so she gave the phone to her friend, who explained what happened.
Madeleine's parents immediately flew from their California home to Kansas. "There are no words for how it feels to hear your child has been hurt like that," says Richard, her father. "I wanted to comfort her, to get there and tell her we were there, we were going to be there."
Richard, who works for a clothing store chain, and Miriam, a homemaker, started a tab on their credit cards that would, over many months, climb to $30,000. They said they paid repeatedly for plane tickets, hotel stays, rental cars and food in Kansas. They wanted to be by their daughter's side as she navigated a confusing justice system.
Terrified she would see her attacker on campus, Madeleine stopped going to classes. In the days after the assault, her father had no choice but to return home to his job. Madeleine and her mother remained in Kansas to talk to each of her professors and coordinate time off from class without repercussions.
Too traumatized to remain at KSU, Madeleine left Kansas, hoping that time at home would help.
The family said they spent thousands moving Madeleine back home, something they did twice, because she tried to return for a semester and simply could not handle being back in a place that reminded her every second of her rape. She was also too emotionally unstable to work the part-time job she had had in high school and where she hoped to work during college breaks.
The depression, anxiety, insomnia and panic attacks she suffered wouldn't be diagnosed as PTSD until years later, she and her father said.
She lost numerous credit hours when she left school for good, she said. Her parents say they lost about $13,000 in tuition. KSU reimbursed the family about $7,000 for room and board when she was unable to stay on campus, Richard said.
Less than a month after his daughter's rape, on December 18, 2007, he wrote a letter to KSU's dean of student life.
Richard said that his daughter was raped in her dorm and that a campus police report was taken. He included the report number. He noted that his daughter had filed a complaint with the office of student life, which under KSU policy is responsible for convening a panel to review complaints of sexual assault. He asked what services the school provides to students and families during times of crisis.
"We have expended considerable financial resources on plane fare, rental cars and hotel bills to make sure that our daughter was given the safety and restoration that she needed during this time," he wrote, "so any relief that you could provide would be welcomed."
Under Title IX
, a federal law that requires gender equity in education, colleges should not make an alleged victim pay certain costs required to continue his or her education, according to Cari Simon
, an attorney at School Violence Law
, who specializes in Title IX.
If the school fails to quickly eliminate violence and address its effects, the school may be compelled to reimburse lost tuition, tutoring costs, mental health counseling and related expenses, she said.
If a school refuses to do so in response to a request made directly by the survivor, there are primarily two ways to force it to do that: file a complaint
with the U.S. Department of Education's Office of Civil Rights
or file a civil suit.
(KSU is among 146 colleges and universities under investigation
by the Department of Education's Office of Civil Rights for possible violations of the federal law on the handling of sexual violence and harassment complaints. The department does not disclose details of the complaints, but lists dates that the two cases that triggered their examination of KSU were filed -- August 4, 2014 and April 20, 2015.)
Madeleine and her parents said they didn't know about her rights under Title IX.
Initially, the family sought legal advice from an attorney but chose not to go down that path because they were afraid a legal battle might be too much on Madeleine and they wanted to focus on getting her well, Richard said. It's unlikely the family will pursue civil litigation or a Title IX complaint, he said, because Madeleine has made tremendous progress and a legal proceeding could re-traumatize her.
Title IX complaints must be filed within 180 days of the date of the most recent act of discrimination alleged, Simon said. But the Department of Education can grant waivers under certain circumstances, such as if information was intentionally withheld from a complainant, she added.
Madeleine's father said the dean of student life responded to his letter in an email dated more than two weeks later, on January 7, 2008.
In that brief email, the father's questions go largely unanswered. Wrote the dean [verbatim excerpt]: "As to the police...it is their policy to communicate with the student...and with an 'on-going investigation'...they are not going to share much of anything...might be good for you and/or miriam to schedule a time to meet with police together (with madeleine) when you bring her back to the campus."
As to the questions about how the office planned to respond to his daughter's complaint, the dean wrote: "As for the campus sexual violence policy...we conduct a hearing and follow the process as outlined in the policy...however, the very best results generally have come from the police and courts...."
Richard says that email is the only communication he received from the dean's office.
"I got a 'Gee, I'm sorry this happened on our campus. Wish you the best.' It was clear then that we would have to deal with this as a family. We would handle this on our own."
CNN provided Kansas State with a detailed account of the family's description of their experience, including the emails they shared with CNN.
Initially, Kansas State spokesman Steve Logback responded that "due to privacy," the school "will not comment on specific cases."
"The university has a strong policy prohibiting discrimination, including sexual violence, and provides a multitude of resources and assistance to students," Logback said in an emailed statement.
Kansas State spokesman Jeffery Morris later added to Logback's reply, saying that from the day of Madeleine's assault to January 2009, KSU staff "communicated with the student and/or family members via multiple emails and phone calls. University staff also participated in at least five in-person meetings with the student and/or family members. Additionally, university staff communicated with professors and others to assist with academic planning and accommodations."
CNN conveyed KSU's responses to Madeleine and her parents.
"That's ridiculous to hear," Madeleine said. "That's such a lie. It's hard to hear that."
Richard said he was unsure if the university response included times that the campus police contacted the family. He said the family did speak with police, but maintains that the family received no communication from university officials other than the single email.
KSU does not have a policy regarding financial assistance following a sexual assault, Morris said, adding that a member of Madeleine's family "acknowledged receiving information provided by university staff" regarding the crime victims compensation fund in Kansas.
But Madeleine's father says he and his wife were not contacted by the university; it was the Riley County prosecutors' office that applied on Madeleine's behalf to have some counseling costs covered by the victim's compensation fund.
The fund, Richard said, covered 80% of her weekly counseling sessions that cost $140 each visit. There was a cap on the amount of money provided, and Madeleine exhausted her allotment after eight months, her father said.
Finally, asked about the tuition money Madeleine's family says they forfeited, Morris emailed, "We do not agree with the allegations, but will not respond in detail to a specific situation in order to protect student privacy."
It is extremely painful for the family to dredge up memories of what happened at Kansas State. Madeleine and her parents try not to think about what she lost. But when they consider the tally, it includes this:
Nearly eight years after she left KSU, Madeleine graduated in May from a small, private college close to home. She chose that school, she said, because it's gated, has security cameras everywhere and keeps close tabs on who comes on campus and who leaves.
She lost years that would have been spent in the workforce, had she been able to graduate from KSU in four years.
And becoming a journalist who reports on television is unthinkable to her now.
Being raped left her "feeling dirty and undervalued," she told CNN. "I don't want to be seen, I don't want to be out there like before."
After three years of working with a psychologist who specializes in PTSD, she no longer has nightmares. She wishes someone had suggested she see a psychologist immediately rather than counselors, who generally have less training.
As she struggled, she says, she lost friends. "They didn't know how to talk to me."
But she has been buoyed by tremendous understanding from her family and her church. Not long ago, she stood in front of the congregation and, for the first time, publicly described her attack. She says it felt empowering.
In 2014, she began an organization that connects sexual assault survivors and encourages them to share their stories in the hope of lessening shame and trauma.
Madeleine's parents have sought therapy to grapple with what her attacker cost the entire family. Richard, a man of deep religious faith, has struggled with the rage he feels toward her attacker, particularly when he was freed from prison.
Miriam said she felt as though she took on her daughter's pain. "I was trying to carry it for her," she said.
The couple worries about the price their younger sons have also paid. "While Madeleine's mom and I were focusing on her, a lot of the boys' emotional needs weren't met," Richard said, pausing. "I've heard our sons express some pain and anguish over that."
"Even though they had no understanding of it (at the time of the assault), they also had to deal with the pain," Miriam said. "There were times when we didn't celebrate Christmas because we were taking care of Madeleine. They were not attended to well. They had to give up a lot."
Madeleine knows her parents spent a lot of money helping her. Her father has tried to shield her from that.
"We did what it took as parents," he says. "I wish the university had done their job."
Laura's case: Facing medical bills -- and more
Laura Marshall did everything she could to see that her rapist was identified and brought to justice.
She underwent a long and traumatizing forensic examination at New York-Presbyterian Hospital, where she was rushed by ambulance on November 11, 2010, after a stranger choked and raped her.
"I wanted him to pay," she remembers.
Instead, less than two weeks later, Marshall got a big bill in the mail.
It was from the hospital, dated November 22, 2010, and charged her for "emergency services" in the amount of $1,427.96.
The next day, she said she received a bill for $522.00 from the New York Fire Department and Emergency Management Services for the ambulance that took her to the hospital.
On December 3, 2010, she got a statement, she told CNN, from the hospital for $231.00 for her emergency room visit.
She provided copies of the bills to CNN.
"All I could do is stare at them and panic," recalled Marshall, who was 21 when a man accosted her, forced his way into her Manhattan apartment and raped her. "I just didn't know what to do. I could barely keep it together. I wasn't keeping it together. I had no idea how I was going to pay."
When Congress reauthorized the Violence Against Women Act in 2005, language was added requiring states to reimburse for rape exams meant to gather evidence from a victim's body. In most states, federal and state victim compensation funds, financed chiefly by fines paid by convicted offenders, are billed for that service.
The bill Marshall received for $1,427.96 does not explicitly state it is for a rape exam, but she says that's the service she received.
In New York, a hospital must give a victim the option to sign a consent form to allow the bill for the exam and related treatment to be sent directly to the New York Office of Victim Services
, explained attorneys John Watson and Shelby Foster, who work for that office.
"No patient should ever be billed for their exam or any related treatment costs" if they sign the form, Watson said.
Transportation costs, like an ambulance, are not automatically reimbursed by victim services, Watson said, though someone can apply to the office to have that expense reimbursed.
Marshall, who wanted her last name used in this story despite CNN's policy not to identify sexual assault survivors, said she was on her parents' insurance at the time. The last thing she was thinking about as she lay on an examination table, harsh fluorescent lights overhead, was keeping track of forms she'd signed.
A few days after her rape -- and without any thought that she might, days later, be billed for treatment -- Marshall met with a hospital counselor who told her about the Office of Victim Services, she said. She doesn't recall the counselor explaining that her rape examination and related costs should not be billed to her.
In the months that followed, Marshall said she and her mother made call after call to the Office of Victim Services to see if her expenses could be covered. The office covered a week of lost wages after she took a short break from her job to deal with the onslaught of police interviews.
She and her mother called the hospital, too, but were unable to get anyone to clearly explain why Marshall was billed, she said. They called their insurance company and also got no answers.
Foster said it does sometimes happen that a victim will receive bills that should have been sent directly to victim services, but she said it was extremely rare.
There's actually been an uptick in New York in the number of sex assault victims who have been incorrectly billed for their rape exams, the Office of Victim Services said in a July 2015 memo
to hospital CEOs and emergency department directors. "This letter serves as a reminder of the laws and regulations related to the reimbursement" of rape exams in New York, it read.
The Office of Victim Services offers training to hospitals on the law governing billing and sexual assault victims, a spokesperson told CNN.
Nationwide, it appears that improper billing is uncommon. An exhaustive national study
conducted in 2010 by the nonprofit Urban Institute concluded that medical care and forensic evidence collection are more widely accessible to victims if they do not have to bear the financial burden of those services. Most victims receive free exams without ever having to pay any upfront expenses.
"Some of the staff we interviewed reported that a victim would very occasionally be billed by mistake," the group reported, "but this seemed to be an infrequent occurrence."
An Office of Victim Services spokesperson told CNN that it could not determine why the caseworker Marshall spoke with in the office -- who has since retired -- had not flagged the problem earlier. Foster offered to help, and CNN put her in contact with Marshall.
Citing privacy concerns, Foster could not speak directly with CNN about Marshall's case. But Marshall outlined the outcome this way:
She says Foster told her that she signed the consent form that would have designated that the Office of Victim Services be sent the bill for her exam and related treatment. The office has two separate departments: one that pays providers directly, and one that pays victims. The department that pays providers had received a copy of the bill for Marshall's rape exam and paid it as it should have, back in December 2010.
A victim services spokesperson told CNN that the office does not have a procedure to notify victims that it received bills from medical providers and paid them. So for months after victim services paid the bill, Marshall said she and her mother continued to make calls, worrying about paying.
Only after CNN put Marshall in touch with the Office of Victim Services lawyer was she finally able to learn, earlier this month, what happened.
"Not until today -- a week short of 5 years after my assault -- did I get real confirmation and a date that OVS had paid the hospital."
Marshall said Foster apologized but blamed the hospital for billing her in the first place.
It's ultimately the hospital's responsibility, she said, to correct any mistake.
CNN also provided a detailed summary of Marshall's story to the hospital. Through an outside public relations representative, Adam Pockriss, the hospital declined to comment.
Over the years, Marshall told CNN, she'd occasionally check her credit report to see if the outstanding hospital charges had been reported.
She'd never seen any indication that they had.
Now she knows why.
Lawrence Elliott, who court records show had served prison time in New York for rape between 1993 and 2001, was arrested several days after Marshall's assault and charged with multiple offenses including predatory sexual assault, burglary, robbery and kidnapping.
Marshall planned to testify against him. But just before the proceeding began, Elliott pleaded guilty to predatory sexual assault. At his sentencing hearing, she spoke.
Looking at him, she said, "I want to be, and I will be, your last victim."
He was sentenced to 28 years to life for a drug charge and predatory sexual assault. He is imprisoned in New York.
Reflecting on the day that changed her life, Marshall said she's gained a kind of toughness.
"It's hard to say what I was like before the assault," she said. "I was someone I don't recognize anymore."
The ordeal steeled her in every way. She used that armor to battle other financial worries after her rape: She didn't feel safe living in the apartment where she was raped so she broke her lease and moved, which cost her thousands.
She took a break from her part-time job and lived on her savings, splitting her time between trying to find a good mental health counselor for post-traumatic stress and meeting with police and prosecutors.
And though she was stressed about doing well enough in school to keep her scholarship money, she took a semester off without facing tuition penalties.
She returned to school the next semester and took extra classes so she could graduate on time.
Marshall is thinking again about her one-time dream: to become a writer. She's working on a book about her assault.
For the national magazine Salon.com, she wrote
about how people treated her after her rape. It's a Hollywood fantasy, she said, that every rape victim will be helped through the justice system by an empathetic and skilled professional.
"People seem to think Olivia Benson is real... she isn't," she said of the fictional "Law & Order: Special Victims Unit" detective.
"I tried to explain it to someone once," she wrote. "It's like surviving your own murder, sort of. Ever wonder who would show up at your funeral? Or, more to the point: Who would actually be sad? Rape taught me: fewer than I'd thought."