A judge declared actor and comedian Bill Cosby a "sexually violent predator" on Tuesday as a first step toward sentencing the 81-year-old comedian for drugging and sexually assaulting a woman over a decade ago.
Ms Constand, now 45, said she has suffered with anxiety and self-doubt for years in a statement submitted to the court.
The classification means Cosby must undergo lifetime counseling and report quarterly to authorities.
According to the state sentencing guidelines for similar offenses, Cosby could have conceivably gotten anywhere between 22 and 36 months in prison (plus or minus 12 months). Constand and the other accusers present are said to have remained expressionless as well.
Prosecutors are expected to seek a lengthy sentence, citing the nature of Cosby's crime as well as his alleged history of misconduct.
Montgomery County Court of Common Pleas Judge Steven O'Neill also made a decision to designateCosby a "sexually violent predator" under Pennsylvania law. O'Neill allowed five of them to testify at trial, while others came to watch the court proceedings.
The judge ruled on Cosby's "sexually violent predator" status after a psychologist for the state testified that the entertainer appears to have a mental disorder that gives him an uncontrollable urge to have sex with women without their consent.
During the sentencing hearing, it was expected defense attorneys pointed to Cosby's age - he is 81 - declining health, and the fact that this is his first criminal conviction to try and persuade the judge to offer a shorter sentence.
"This was a serious crime", said Judge Steven O'Neill from the bench at the Montgomery County Courthouse outside of Philadelphia.
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"The suggestion that Mr. Cosby is unsafe is not supported by anything other than the frenzy", Green said, as demonstrators gathered outside the courthouse.
Constand writes in a victim-impact statement released Tuesday that Cosby's 2004 attack on her was just "the tip of the iceberg" for the suffering that followed.
His wife of 54 years, Camille, was not in court. At that point, she said Cosby helped her to a couch and assaulted her.
During his sentencing, Cosby's legal team argued that his age and blindness should be taken into account, and tried to whittle his sentence down from years of jail time to house arrest.
Cosby spokesperson Andrew Wyatt said the former TV star planned to remain silent when given the opportunity to address the court.
Cosby is the first celebrity of the #MeToo era to be sent to prison.
His lawyers have already vowed to appeal the conviction.
Cosby did not make any statement before sentencing.
It was the second time Cosby had stood trial for the allegations, after an earlier jury failed to reach a verdict in June 2017. He will be classified as a "sexually violent predator" for the remainder of his life. They said he used "his stature at Temple University, and, of course, his acting success and public persona to facilitate his drug-induced sexual assault".