Military sexual trauma

Definition

Military sexual trauma (MST) refers to sexual assault, threatening sexual harassment that occurred while a person was in the military, including any sexual activity in which one is involved against one’s will, or rape. The behavior may include physical force, threats of negative consequences, implied promotion, promises of favored treatment, or intoxication of either or both the perpetrator or victim. Other events that may be categorized as MST may include unwanted sexual contact, threatening, offensive remarks, and unwelcome sexual advances. The Veterans Health Administration (VHA) provides medical and mental health services free of charge to enrolled veterans who report MST and has implemented universal screening for MST among all veterans receiving VA health care.[1]

Prevalence

Military sexual trauma is a serious issue faced by the United States armed forces. In 2012, 13,900 men and 12,100 women who were active duty service members reported unwanted sexual contact [2] while in 2016, 10,600 men and 9,600 women reported being sexually assaulted.[3] Further, there were 5,240 official reports of sexual assault involving service members as victims in 2016; however, it is estimated that 77% of service member sexual assaults go unreported.[4] More specifically, prevalence of MST among veterans returning from Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq, was reported to be as high as 15.1% among females and 0.7% among males.[5] In a study conducted in 2014, 196 female veterans who had deployed to OIF and/or OEF were interviewed and 41% of them reported experiencing MST.[6] As a result of these and similar findings, 17 former service members filed a lawsuit in 2010 accusing the Department of Defense of allowing a military culture that fails to prevent rapes and sexual assaults.[7] According to the Department of Defense Task Force on Sexual Violence (2004)[8] perpetrators of sexual assault were often male, serving in the military, and knew the victim well.

Reporting

Currently, the U.S. military allows victims of MST to make either restricted or unrestricted reports of sexual assault. This two tier system includes restricted (anonymous) and unrestricted reporting. A restricted report, allows victims to receive access to counseling and medical resources without disclosing their assault to authorities or seeking litigation against the perpetrator(s). This is different from an unrestricted report which involves seeking criminal charges against the perpetrator, eliminating anonymity.[9] The restricted reporting option is meant to reduce negative social consequences suffered by MST survivors, increase MST reporting and in doing so improve the accuracy of information concerning MST prevalence.[10] According to the DOD Annual Report on Sexual Assault in the Military (2016) [11] in 2015, there were 4,584 Unrestricted Reports involving Service members as either victims or subjects and 1,900 Restricted Reports involving Service members as either victims or subjects. The Services do not investigate Restricted Reports and do not record the identities of alleged perpetrators.[12] Service members who experience MST are eligible for medical care, mental healthcare, legal services, and spiritual support related to MST through the VA.[13][14]

U.S. military members appear to fear repercussions, retaliation, and the stigma associated with reporting MST. The reasons service members do not report military sexual assaults include concerns about confidentiality, wanting to “move on”, not wanting to seem “weak”, fear about career repercussions, fear of stigmatization, and worry about retaliation by superiors and fellow service members.[15][16][17] Additionally, survivors of MST may believe that nothing will be done if they report a sexual assault, they may blame themselves, and/or they may fear for their reputation.[18][19]

Effects of Stigma on Reporting Rates

Stigma is a significant deterrent to reporting MST. Many military service members do not report sexual abuse due to fear about not being believed, worry about career impact, fear of retribution, or because their victimization will be minimized with comments such as “suck it up.”[20] Additionally, perceived stigma associated with seeking mental health treatment after experiencing MST affects reporting.[21] Service members often do not disclose any type of trauma (sexual assault or battlefield trauma) until asked specifically by a mental health professional due to mental health stigma, worry about career difficulties, or because they wish to preserve their masculine image.[22][23]

Additionally, reporting MST sometimes results in an individual being diagnosed with a personality disorder, resulting in a discharge other than honorable, and reducing access to benefits from the VA or state.[24] A diagnosis of a personality disorder also discounts or minimizes the credibility of the victim and may result in stigmatization by the civilian community. Many survivors of MST report that they experience rejection from the military and feel incompetent after an Unrestricted Report.[25]


Consequences of Reporting

In spite of increased access to medical and mental health resources there are also important drawbacks to unrestricted reports of MST. MST survivors often report a loss of professional and personal identity. They are also at increased risk of re-traumatization and retaliation through the process of getting help. Service members may experience re-traumatization through blame, misdiagnosis, and being questioned about the validity of their experience.[26][27] Retaliation from reporting a sexual complaint may have distressing consequences for the victim and weakens the respectful culture of the military. Retaliation can refer to reprisal, ostracism, maltreatment or abusive behavior by co-workers, exclusion by peers, or disruption of their career. The Department of Defense Task Force on Sexual Violence (2004)[28] reported that unkind gossip was the most common problem that members experienced at work in response to a MST report. In 2015, 68% of survivors reported at least one negative experience associated with their report of sexual assault.[29] The Department of Defense Annual Report on Sexual Assault in the Military (2016)[30] indicates that approximately 61% of retaliation reports involved a man or multiple men as alleged retaliators, while nearly 27% of reports included multiple men and women as retaliators. The majority (73%) of retaliators were not the alleged perpetrator of the associated sexual assault or sexual harassment. More than half (58%) of the alleged retaliators were in the chain of command of the reporter, followed by peers, co-workers, friends, or family members of the reporter, or a superior not in the reporters chain of command. Infrequently (7%), the alleged sexual perpetrator was also the alleged retaliator.[31]

85% of the members of the military are active duty and male. Although more men than women in the military experience sexual assault, a larger proportion of female victims report their assault to military authorities.[32] In 2004, of service members who said they reported their experiences, 33% of women and 28% of men were satisfied with the complaint outcome, meaning approximately two thirds of women and men were dissatisfied. Service members who felt satisfied with the outcome of their report indicated that the situation was corrected, the outcome of the report was explained to them, and some action was taken against the offender. Service members who were dissatisfied with the outcome reported that nothing was done about their complaint.[33] Since changes in reporting standards were implemented in 2012, military sexual assault reporting has increased significantly.[34] Since this change, most service members report instances of MST to their direct supervisor, another person in their chain of command, or the offender’s supervisor, rather than to a military special office or civilian authority.[35]

Individuals who make a report and deny mental health evaluations could be given a dishonorable discharge for making false allegations. Therefore, victims are sent the message to “keep quiet and deal with it” rather than reporting the assault and possibly losing their career and military benefits. In fact, 23% of women and 15% of men reported that action was taken against them because of their complaint.[36] Additionally, according to an investigation by the Human Rights Watch in 2016,[37] many survivors reported they received more disciplinary notices, were seen as “troublemakers”, assigned undesirable shift assignments, were intimidated by drill sergeants, were threatened by peers with comments such as “you got what you deserved”, and were socially isolated and further assaulted due to fear of more retaliation after an initial report. Psychological/Physiological Difficulties

Servicemembers who experiencing a MST may experience increased emotional and physical distress as well as feelings of shame, hopelessness, and betrayal. Some of the psychological experiences of both male and female survivors include: depression, symptoms of post-traumatic stress Disorder (PTSD), mood disorders, dissociative reactions, isolation from others, and self-harm. Medical symptoms survivors have experienced include sexual difficulties, chronic pain, weight gain, and gastrointestinal problems.[38][39][40]


Interpersonal Difficulties

MST is a significant predictor of interpersonal difficulties post-deployment.[41] Holland and colleagues (2015)[42] found that survivors who perceived greater logistical barriers to obtaining mental health care reported more symptoms of depression and PTSD. Particularly for women veterans, PTSD and suicide are major concerns.[43] Males experiencing MST are associated with greater PTSD symptom severity, greater depression symptom severity, higher suicidality, and higher outpatient mental health treatment.[44] In general, male veterans who report experiencing MST are younger, less likely to be currently married, more likely to be diagnosed with a mood disorder, and more likely to have experienced non-MST sexual abuse either as children or adults than military members who have not been victimized.[45][46][47] However, the strongest predictor of any of these negative mental health outcomes, for either gender, includes anticipating public stigma (i.e., worrying about being blamed for the assault).[48]

See also

References

  1. ↑ Lipari RN, Lancaster AR. Armed Forces 2002 Sexual Harassment Survey. Arlington, VA: Defense Manpower Data Center; 2003.
  2. ↑ Department of Defense (2012) http://www.ncdsv.org/images/DoD_Active-duty-service-members-reporting-unwanted-sexual-contact.pdf
  3. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  4. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  5. ↑ Department of Defense Task Force on Sexual Violence. (2004) Sexual Harassment Survey of Reserve Component Members. Available at http://www.ncdsv.org/images/DOD_SexualHarassmentSurveyReserveComponentMembers_2004.pdf
  6. ↑ Department of Defense (2014). Demographics. Profile of the Military Community. Retrieved from http://download.militaryonesource.mil/12038/MOS/Reports/2014-Demographics-Report.pdf
  7. ↑ Department of Defense (2012) http://www.ncdsv.org/images/DoD_Active-duty-service-members-reporting-unwanted-sexual-contact.pdf
  8. ↑ Department of Defense Task Force on Sexual Violence. (2004) Sexual Harassment Survey of Reserve Component Members. Available at http://www.ncdsv.org/images/DOD_SexualHarassmentSurveyReserveComponentMembers_2004.pdf
  9. ↑ Conrad, P.L., Young, C., Hogan, L., & Armstrong, M.L. (2014). Encountering women veterans with military sexual trauma. Perspectives in Psychiatric Care, 50, 280-286
  10. ↑ Department of Defense Task Force on Sexual Violence. (2004) Sexual Harassment Survey of Reserve Component Members. Available at http://www.ncdsv.org/images/DOD_SexualHarassmentSurveyReserveComponentMembers_2004.pdf
  11. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  12. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  13. ↑ Conrad, P.L., Young, C., Hogan, L., & Armstrong, M.L. (2014). Encountering women veterans with military sexual trauma. Perspectives in Psychiatric Care, 50, 280-286
  14. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  15. ↑ Conrad, P.L., Young, C., Hogan, L., & Armstrong, M.L. (2014). Encountering women veterans with military sexual trauma. Perspectives in Psychiatric Care, 50, 280-286
  16. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  17. ↑ Greene-Shortridge, T.M., Britt, T..W., & Castro, C.A. (2007). The stigma of mental health problems in the military. Military Medicine, 172(2), 157-161
  18. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  19. ↑ Greene-Shortridge, T.M., Britt, T..W., & Castro, C.A. (2007). The stigma of mental health problems in the military. Military Medicine, 172(2), 157-161
  20. ↑ Valente, S. & Wright, C. (2007). Military Sexual Trauma: Violence and Sexual Abuse. Military Medicine, 172 (3), 259-265
  21. ↑ Greene-Shortridge, T.M., Britt, T..W., & Castro, C.A. (2007). The stigma of mental health problems in the military. Military Medicine, 172(2), 157-161
  22. ↑ Brown, N. B., & Bruce, S. E. (2015). Stigma, Career Worry, and Mental Illness Symptomatology: Factors Influencing Treatment-Seeking for Operation Enduring Freedom and Operation Iraqi Freedom Soldiers and Veterans. Psychological Trauma: Theory, Research, Practice, And Policy, doi:10.1037/tra0000082.
  23. ↑ Conrad, P.L., Young, C., Hogan, L., & Armstrong, M.L. (2014). Encountering women veterans with military sexual trauma. Perspectives in Psychiatric Care, 50, 280-286
  24. ↑ Human Rights Watch. Booted. Lack of Recourse for wrongfully discharged US military rape survivors. (2016). https://www.hrw.org/sites/default/files/report_pdf/us0516_militaryweb_1.pdf
  25. ↑ Northcut, T.B., & Kienow, A. (2014). The trauma trifecta of military sexual trauma: A case study illustrating the integration of mind and body in clinical work with survivors of MST. Clinical Social Work, 42, 247-259. DOI 10.1007/s10615-014-0479-0
  26. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  27. ↑ Human Rights Watch. Booted. Lack of Recourse for wrongfully discharged US military rape survivors. (2016). https://www.hrw.org/sites/default/files/report_pdf/us0516_militaryweb_1.pdf
  28. ↑ Department of Defense Task Force on Sexual Violence. (2004) Sexual Harassment Survey of Reserve Component Members. Available at http://www.ncdsv.org/images/DOD_SexualHarassmentSurveyReserveComponentMembers_2004.pdf
  29. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  30. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  31. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  32. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  33. ↑ Department of Defense Task Force on Sexual Violence. (2004) Sexual Harassment Survey of Reserve Component Members. Available at http://www.ncdsv.org/images/DOD_SexualHarassmentSurveyReserveComponentMembers_2004.pdf
  34. ↑ Department of Defense Annual Report on Sexual Assault in the Military Fiscal Year 2015 (2016). Retrieved from http://www.sapr.mil/public/docs/reports/FY15_Annual/FY15_Annual_Report_on_Sexual_Assault_in_the_Military.pdf
  35. ↑ Department of Defense Task Force on Sexual Violence. (2004) Sexual Harassment Survey of Reserve Component Members. Available at http://www.ncdsv.org/images/DOD_SexualHarassmentSurveyReserveComponentMembers_2004.pdf
  36. ↑ Department of Defense Task Force on Sexual Violence. (2004) Sexual Harassment Survey of Reserve Component Members. Available at http://www.ncdsv.org/images/DOD_SexualHarassmentSurveyReserveComponentMembers_2004.pdf
  37. ↑ Human Rights Watch. Booted. Lack of Recourse for wrongfully discharged US military rape survivors. (2016). https://www.hrw.org/sites/default/files/report_pdf/us0516_militaryweb_1.pdf
  38. ↑ Northcut, T.B., & Kienow, A. (2014). The trauma trifecta of military sexual trauma: A case study illustrating the integration of mind and body in clinical work with survivors of MST. Clinical Social Work, 42, 247-259. DOI 10.1007/s10615-014-0479-0
  39. ↑ U.S. Department of Veterans Affairs National Center for PTSD. (2015). Military Sexual Trauma. Retrieved from http://www.ptsd.va.gov/public/types/violence/military-sexual-trauma-general.asp
  40. ↑ Valente, S. & Wright, C. (2007). Military Sexual Trauma: Violence and Sexual Abuse. Military Medicine, 172 (3), 259-265
  41. ↑ Mondragon, S.A., Wang, D., Pritchett, L., Graham, D.P., Plasencia, M.L., Teng, E.J. (2015). The influence of military sexual trauma on returning OEF/OIF male veterans. Psychological Services, 12(4), 402-411
  42. ↑ Holland, K.J., Rabelo, V.C., & Cortina, L.M. (2015). Collateral damage: Military sexual trauma and help-seeking barriers. Psychology of Violence, 1-9. doi: http://dx.doi.org/10.1037/a0039467
  43. ↑ Conrad, P.L., Young, C., Hogan, L., & Armstrong, M.L. (2014). Encountering women veterans with military sexual trauma. Perspectives in Psychiatric Care, 50, 280-286
  44. ↑ Schry, A.R., Hibberd, R., Wagner, H.R., Turchik, J.A., Kimbrel, N.A., Wong, M.,…& Strauss, J.L. (2015). Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center Workgroup, & Brancu, M
  45. ↑ Conrad, P.L., Young, C., Hogan, L., & Armstrong, M.L. (2014). Encountering women veterans with military sexual trauma. Perspectives in Psychiatric Care, 50, 280-286
  46. ↑ Mondragon, S.A., Wang, D., Pritchett, L., Graham, D.P., Plasencia, M.L., Teng, E.J. (2015). The influence of military sexual trauma on returning OEF/OIF male veterans. Psychological Services, 12(4), 402-411
  47. ↑ U.S. Department of Veterans Affairs National Center for PTSD. (2015). Military Sexual Trauma. Retrieved from http://www.ptsd.va.gov/public/types/violence/military-sexual-trauma-general.asp
  48. ↑ Holland, K.J., Rabelo, V.C., & Cortina, L.M. (2015). Collateral damage: Military sexual trauma and help-seeking barriers. Psychology of Violence, 1-9. doi: http://dx.doi.org/10.1037/a0039467

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