A brief overview of Military Sexual Trauma for graduate counseling students

2. MILITARY SEXUAL TRAUMA

3. MILITARY SEXUAL TRAUMA
Melissa L. Maskulka
Boston University School of Medicine
April 6, 2009

4. DEFINITION OF MST
MST = Military Sexual Trauma
Sexual harassment and sexual assault that occurs in
military settings
Sexual harassment: gender harassment, unwanted
sexual attention, or sexual coercion
Sexual assault: any sort of sexual activity between at
least two people in which one of the people is
involved against his or her will

5. WHAT MAKES MST DIFFERENT
Military setting may intensify experience
Perpetrators are typically military personnel
Survivors must continue to live and work with
assailants daily
Unit cohesion may create settings where survivors
are strongly encouraged to keep silent or not report,
or have their report ignored

6. MST
Military Sexual Trauma Video on PBS
Reactions?
How do YOU personally feel viewing these stories?

7. FACTS AND FIGURES
MST among VA Healthcare users higher than general military
populations
23% of female users of VA Healthcare report experiencing at least
one sexual assault while in military
From female veterans in the Gulf War - results higher than found in
peacetime military samples:
Sexual assault rate = 7%
Physical sexual harassment = 33%
Verbal sexual harassment = 66%

8. FACTS AND FIGURES
In a large 1995 study, reports stated that, among active duty
populations over a one year period:
sexual harassment = 78% among women and 38% among men
attempted or completed sexual assault = 6% women, 1% men

9. NATURE OF THE ISSUE
Since the Gulf War, MST has been known as a widespread problem within the
military
Most unreported crime in U.S. Military
OEF/OIF soldiers returning to US - difficulty of reporting while overseas
Sexual trauma poses a risk for developing PTSD as high or higher than combat
exposure
NOT a gendered issue, though more prevalent in females
As a gendered issue, 15% of the U.S. Military is comprised of women - a great
increase from past war eras, presenting new challenges to the military culture

10. INCREASED RISK OF MST
Women who joined military at 19 or younger, were of
enlisted rank, and who had experienced childhood
physical or sexual violence 2x more likely to
experience rape
Ranking officer or immediate supervisor behaviors
Mixed gender-sleeping quarters
Assailant alcohol and/or drug abuse

11. BARRIERS TO TREATMENT
Won’t readily seek out VA services (usually)
Dearth of specialized MST programs in the country -
or clinicians trained to deal with MST
Unwillingness to seek out mental health services or
acknowledge PTSD symptoms

12. RELATED HEALTH ISSUES
Increased
depression, substance abuse issues
gynecological and urological issues
neurological issues
GI issues
pulmonary and cardiovascular issues

13. DSM-IV DIAGNOSTIC ISSUES
Post-traumatic Stress Disorders
Substance use disorders
Major depression
Bipolar disorder
Personality disorders (dependent, narcissistic,
borderline, anti-social)
Complex PTSD as a result of childhood sexual abuse

14. ASSESSMENTS
Clinician’s Administered PTSD Scale (CAPS)
PCL
PANAS
Post-traumatic Symptom Scales (Interview and Self-
Report

15. TREATMENT
Cognitive Processing Therapy
Used as a “gold standard” treatment within the
Veterans Administration Hospital System
Exposure therapies (flooding)
Prolonged Exposure Therapy
Acceptance and Commitment Therapy

16. COMMUNITY COUNSELORS/VA HOSPITALS
There will be a delay in MST survivors seeking out VA
assistance
Look for an influx at VA Hospitals 5-10 years after
OEF/OIF
Vet Centers, Community Agencies and Clergy
Centers may hear of these issues first

17. VA INITIATIVES
No service connection required for MST related
treatment
No required duration of service in the military to
receive services
Since 2005, mandated MST screening for all veterans
Each facility has a Military Sexual Trauma Coordinator

18. OUTPATIENT PTSD PROGRAMS
PTSD Clinic Teams
Substance Use PTSD Teams
Women’s Stress Disorder Treatment Teams

19. INTENSIVE PTSD PROGRAMS
Evaluation and Brief Treatment of PTSD Units
PTSD Residential Treatment Programs
PTSD Day Hospitals
PTSD Domiciliary Units
Specialized Inpatient PTSD Units
Women’s Trauma Recovery Program

20. WOMEN’S INTEGRATED TREATMENT
AND RECOVERY PROGRAM
One of a handful of specialized women’s PTSD
treatment programs in the country
Provides services to women with PTSD and
substance use disorders - nearly 68% of them
have experienced MST - either during basic
training, on base, or while overseas (most recently
in Gulf War and OEF/OIF)
Provide cognitive processing therapy and
integrated Seeking Safety treatment as main
trauma treatment modalities

21. IMPLICATIONS FOR COUNSELORS
Accompanying issues:
Co-morbidities
Service Connection
Lack of specialized programs
Of growing concern due to OEF/OIF

22. IMPLICATIONS FOR
COUNSELORS: SELF-CARE
WARNING: This work is emotionally draining!
The nature of this work is all around you - on the
bus, train, Army recruitment centers, television
shows, the news. You CANNOT avoid it!
Your worldview may shift dramatically, especially in
your perceptions of the government, military, and
trauma, and how safe the world may actually be.

23. IMPLICATIONS FOR
COUNSELORS: SELF-CARE
Vicarious traumatization
Self-care activities are necessary
Be aware of your limitations and ability to sit with
traumatic stories

24. SELF-CARE RESOURCES
Help for the Helper (Rothschild)
On Being a Therapist (Kottler)
Therapists Guide to Self-Care (Weiss)
The Therapist’s Workbook: Self-assessment, Self-care,
and Self-improvement exercises for the Mental Health
Professional (Kottler)

25. WORKS CITED
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC.
Hankin, C.S,, Skinner, K.M., Sullivan, L.M., MIiller, D.R., Frayne, S., & Tripp, T.J. (1998). Prevealence of depressive and alcohol abuse symptoms among women VA outpatients who report
experiencing sexual assault while in the military. Journal of Traumatic Stress, 12 (4), 601-612.
Kimmerling, R., Gima, K., Smith,M.W., Street,A. & Frayne,S. (2007). The Veterans Health Administration and Military Sexual Trauma. American Journal of Public Health, 97(12),1-7.
Murdoch, M., & Nichol, K.L. (1995). Women veterans’ experiences with domestic violence and with sexual harassment while in the military. Archives of Family Medicine, 4(5), 411-418.
Military sexual assault. (2007). Retreived March 31, 2009 from PBS NOW official website: http://www.pbs.org/now/shows/336/index.html
Rothschild, B. (2006). Help for the helper: Self-care strategies for managing burnout and stress. W.W. Norton & Company: New York.
Skinner, K.M., et al (2000). Prevalence of military sexual assault among female Veteran Administration outpatients, Journal of Interpersonal Violence, 15, 291-310.
Sadler, A.G., Booth, B. M., Cook, B.L,, & Doebbeling, B.N. (2003). Factors associated with women’s risk of rape in the military environment. American Journal of Industrial Medicine, 43,
262-273.
Street, A. & Stafford, J. (2004). Military Sexual Trauma Isseus in Caring for Veterans, In National Center for PTSD (Ed.), Iraq War Clinician’s Guide. Boston, MA: Department of Veterans
Affairs.
Wolfe, J., Sharkansky, E.J., Read, J.P., Dawson, R., Martin, J.A., & Ouimette, P. C. (1998). Sexual harassment and assault as predictors of PTSD symptomology among US female Persian Gulf
military personnel. Journal of Interpersonal Violence, 13(1), 40-57.