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Military Sexual Trauma


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A brief overview of Military Sexual Trauma for graduate counseling students

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Military Sexual Trauma

  2. 2. MILITARY SEXUAL TRAUMA Melissa L. Maskulka Boston University School of Medicine April 6, 2009
  3. 3. 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
  4. 4. 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
  5. 5. MST Military Sexual Trauma Video on PBS Reactions? How do YOU personally feel viewing these stories?
  6. 6. 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%
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. RELATED HEALTH ISSUES Increased depression, substance abuse issues gynecological and urological issues neurological issues GI issues pulmonary and cardiovascular issues
  12. 12. 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
  13. 13. ASSESSMENTS Clinician’s Administered PTSD Scale (CAPS) PCL PANAS Post-traumatic Symptom Scales (Interview and Self- Report
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. OUTPATIENT PTSD PROGRAMS PTSD Clinic Teams Substance Use PTSD Teams Women’s Stress Disorder Treatment Teams
  18. 18. 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
  19. 19. 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
  20. 20. IMPLICATIONS FOR COUNSELORS Accompanying issues: Co-morbidities Service Connection Lack of specialized programs Of growing concern due to OEF/OIF
  21. 21. 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.
  22. 22. IMPLICATIONS FOR COUNSELORS: SELF-CARE Vicarious traumatization Self-care activities are necessary Be aware of your limitations and ability to sit with traumatic stories
  23. 23. 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)
  24. 24. 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: 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.