Port Macquarie clinical and forensic psychologist Dr Kevin O'Sullivan said people could spend decades before they disclosed sexual abuse.
Some even go to their grave without telling anyone.
The Port News spoke to a number of women who allege they were targeted, groomed and abused by teachers at Port Macquarie High School between the 1970s - 1990s.
The women said the alleged abuse had a devastating impact on their life.
A Facebook group called Teacher's Pet Released was started in relation to Port Macquarie High School and allegations around teacher-student relations.
Up to 42 women have made contact with the page's administrator to share their stories.
Most people experience these events as deeply shameful.Dr O'Sullivan
Read the full story: Teacher sex allegations; former Port High students seek legal action
Dr O'Sullivan identified "shame" and "compliance with authority" as the main barriers that prevented disclosure.
"Most people experience these events as deeply shameful," he said.
"We are not inclined to talk about things we are ashamed of.
"The more ashamed you are the more closely you will guard those secrets."
He said the "social and family environment" the victim grew up in also had a bearing on disclosure.
"If you don't live in an environment where it is possible to say something and be believed you won't disclose," he said.
"Conversations have context."
Creating a safe place for victims to disclose abuse is important.
"The most important thing to provide after trauma is safety," he said.
"They need to know that you will respect their story.
"I have had people come to therapy and say, 'I wasn't sure you would believe me' even though it is my job to listen to people, so you can imagine how hurt this person is to doubt they will be believed."
Children are usually abused by people in positions of trust who have some authority over them or some status in the community.
The power and status of the perpetrator can lead the victim to blame themselves.
"We're brought up to trust people like teachers, clergy and carers, so when they breach that trust and behave abusively the child often finds it very hard to believe that it's the abuser who has done the wrong thing, hence they will blame themselves," said Dr O'Sullivan.
Dr O'Sullivan has worked in the criminal justice system, with perpetrators of sexual abuse.
"There is an extreme level of narcissism," Dr O'Sullivan said regarding the abuser.
"They structure the world, 'this is how it is, I'm that kind of guy'."
Impact of abuse
People react to abuse in all different ways.
"Children feel a lot of confusion," he said.
Self-harm can be a common response.
"One of the things about self-harm is that it shifts the focus of the pain, it gives the person something tangible, a cut or a burn on the arm or the leg to feel rather than the emotional pain," Dr O'Sullivan said.
He said "going off the rails" could also be a common response.
"Performance at school often gets a lot worse, suddenly behaviour changes, kids withdraw or seek out peers with whom they use alcohol and/ or drugs," he said.
Dr O'Sullivan has worked with many men in Corrective Services, coming across familiar stories.
"Many of the men I've worked with in Corrections have been deemed 'uncontrollable' as youngsters or teenagers and been placed into a boys' home for discipline's sake," he said.
"The reality is that many of those youngsters would have been acting out as a result of abuse."
He maintains "human beings are not stupid" and do things for a reason.
"If a person starts abusing alcohol or taking heroin, of course that's a terrible long-term plan, but at the time it takes away the pain," he said.
When sexuality has been introduced into a person's life at an inappropriate time and an inappropriate way one of the things that can be learnt is my body is usable for this.Dr O'Sullivan
Sexuality can also be affected by abuse.
"When sexuality has been introduced into a person's life at an inappropriate time and an inappropriate way one of the things that can be learnt is my body is usable for this," he said.
"Boundaries are breached and taboos are broken and the young person becomes confused about what is permissible."
Sometimes this is complicated by ongoing contact with the abuser because they are part of the victim's social circle.
"People can walk around acknowledging what has happened, even speaking about what has happened but being unable to do anything about it because they remain in some type of relationship to the perpetrator," he said.
"This leaves some people in a state of limbo."
The final report by the Royal Commission into Institutional Responses to Sexual Abuse found the most common impact of child sexual abuse was on the mental health of the victim.
"The impact includes: depression, anxiety and post-traumatic stress disorder," according to the Commission.
The Commission also found victims exhibited difficulties with trust and intimacy.
Victims also told the Commission they developed addictions after using alcohol or other drugs to manage the psychological trauma of abuse.
Healing from abuse
There is hope.
Dr O'Sullivan believes it is possible to heal from abuse.
"I am optimistic because I have seen many people come through abuse and out the other side to live happy, productive lives," he said.
"To do this, people need a safe place to tell their story and be believed.
"Some people later choose to go public and go to court, but for many that is too great an ask, especially given the uncertainty of the outcome.
"The anger that sometimes follows abuse can be a very positive indication that the survivor is rejecting the actions of the abuser."
Dr O'Sullivan said the community plays a role in the healing process.
"As a culture we can "minimise wrongdoing", he said.
"We might say he has a 'colourful personality' when he is an out and out criminal.
"Or a 'bit of a sleaze' when he is a child abuser.
"We minimise because we don't want to be implicated.
"We can have cognitive dissonance ... we have a certain view of the world and any new information has to be in accord with that."
Port High allegations update
Port Macquarie law firm Scott Mackenzie Lawyers is providing legal representation to women who allege abuse at Port Macquarie High School between the 1970s-1990s.
Kerrin Lawyers in Brisbane had previously been representing the women.
Mr Scott said they were reviewing "each and every alleged incident by a number of ex-students of Port Macquarie High School".
"The new legal team is solicitors Mandy Mackenzie and Todd Scott of Scott Mackenzie Lawyers who have hired barristers Dominic Toomey SC and Dean Woodbury," Mr Scott said.
"Once that process is completed we anticipate that Statements of Claim will be filed against the State of New South Wales (NSW Department of Education) in addition to the respective individuals."
Mr Scott said the firm was being contacted on a "near daily basis" by people regarding the allegations.
We are currently reviewing each and every alleged incident by a number of ex-students of Port Macquarie High School.Todd Scott
"We can confirm that we have already been contacted by a Sydney Law Firm that have been appointed to act on behalf of the State of New South Wales in relation to alleged child abuse by former students of Port Macquarie High School," Mr Scott said.
"The State of NSW is offering counselling (free of charge) to those persons who claim to have been the subject of child abuse."
The NSW Department of Education was contacted for comment.
"The NSW Department of Education abhors the abuse of children in any circumstances; it works to develop, then implement policies and procedures that heighten awareness of child protection in public schools," a spokesman for the NSW Department of Education.
"The department works collaboratively with the survivors of child abuse and their legal representatives to reduce the risk of exacerbating the trauma or re-traumatising survivors.
The department is also working with the legal representative of survivors to facilitate access to available records during the historical period.A NSW Department of Education spokesperson
"While it is not appropriate to comment on individual cases, the department is aware of a number of historical matters concerning Port Macquarie High School and in response has offered counselling through the legal representative of persons who may be affected.
"The department is also working with the legal representative of survivors to facilitate access to available records during the historical period.
"The department is committed to ensuring that survivors are treated fairly and afforded the dignity and respect they deserve."