D EPA R TM EN T OF V E TE RA N S A FFAI RS A Primer on Military Sexual Trauma for Mental Health Clinicians What is What Should I Know About Working With Military Sexual Trauma? Survivors of Military Sexual Trauma? The term military sexual Both women and men experience MST. Though rates of MST are trauma (MST) is defined in higher among women, the large number of men in the military means U.S. Code as “physical assault of that there are actually only slightly fewer men than women seen in VA a sexual nature, battery of a who have experienced MST. sexual nature, or sexual Sexual trauma survivors can struggle with distinct issues. For harassment [repeated, example, sexual trauma is an interpersonal trauma involving harm from unsolicited verbal or physical another human being, often someone trusted. This can lead sexual contact of a sexual nature which trauma survivors to struggle more with intimacy, trust, safety and other is threatening in character] core features of relationships than survivors of other traumatic which occurred while experiences. With sexual trauma occurring in the military, certain aspects a Veteran was serving on active of the experience, such as possibly having had ongoing contact with duty or active duty for training.” perpetrators afterwards, may also create unique issues for survivors’ This may include any sexual recovery. activity where someone was Although the reactions men and women have to sexual trauma are involved against his or her will, similar in some ways, they may also struggle with different issues. such as if he or she was Few men believe they are vulnerable to sexual trauma; this can make pressured into sexual activities experiencing it that much more confusing for them. They may question (e.g., with threats of their masculinity or sexual orientation. For women, sexual trauma may consequences for refusing to be strengthen preexisting concerns about safety, particularly in sexually cooperative or with environments dominated by men. They may struggle to reconcile implied faster promotions or victimization with the toughness they had to exhibit as a woman in the better treatment in exchange for military. Gender norms for help-seeking and expression of distress also sex), unable to consent to sexual often shape survivors’ behavior. activities (e.g., when MST survivors may have experienced multiple traumas. Given that intoxicated), or physically forced the effects of trauma appear to be cumulative over time, these individuals into sexual activities. Other are more likely to present with more severe symptoms that may be more experiences that fall into the resistant to improvement. category of MST include You may be the first person the survivor has ever told about his or unwanted sexual touching or her experiences of MST. Self-blame, shame, and fear of retaliation or grabbing; threatening offensive negative reactions from others often lead sexual trauma survivors to remarks about a person’s body remain silent about their experiences. This makes it especially important or sexual activities; and/or to screen all patients for sexual trauma and to respond empathically to threatening and unwelcome disclosures. sexual advances. Associated Conditions Sexual assault is more likely to result in symptoms of PTSD than are most other types of trauma, including combat. Symptoms of depression and VA provides free care for substance abuse are also common. Even survivors without problems at the conditions related to MST. level of formal diagnosis may still struggle with issues related to emotional Veterans do not need to be service dysregulation, interpersonal functioning, and meaning-making about their connected and may be able to experiences. Sexual trauma can also have severe consequences for physical receive this free care even if they health and is associated with gastrointestinal difficulties, chronic pain, are not eligible for other VA care. chronic fatigue, and headaches. Continued on other side D EPA R TM EN T OF V E TE RA N S A FFAI RS A Primer on Military Sexual Trauma for Mental Health Clinicians Treatment Approaches Best practices for treatment depend on the specific mental health conditions Documentation involved but some commonly used protocols include: Issues Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and other exposure-based therapies for PTSD It is good clinical practice to Acceptance & Commitment Therapy (ACT) for anxiety and depression screen all patients for Dialectical Behavior Therapy (DBT) for emotional dysregulation and experiences of sexual trauma interpersonal deficits, particularly for patients who have experienced and VA mandates screening multiple traumas all Veterans for experiences Coping skills training focused on stress management, assertiveness, and of MST in particular. Even if distress tolerance can be additional important components of treatment. a Veteran has previously Psychoeducation and normalization of symptoms are also often helpful. been screened, it is helpful to Common Treatment Themes include questions about sexual trauma in all mental Treatment of sexual trauma survivors is similar in many ways to treatment health intakes, as Veterans with other trauma survivors. There are, however, certain issues that arise may be more open to more frequently and should be monitored, such as: disclosure in those settings. Interpersonal difficulties. Survivors may have particularly strong Be sure to complete the reactions to situations in which one individual has power over another, MST clinical reminder in such as employee-employer or patient-healthcare provider relationships. CPRS after screening. This Self-blame and self-doubt. Survivors may blame themselves for their activates the MST checkbox experiences of sexual trauma or question their decision-making at the in a Veteran’s encounter time. They may question their general ability to judge others’ intentions form, thus giving him or her or trustworthiness given the occurrence of the trauma. access to free MST-related Problems with sexual functioning and sexuality. Even survivors care (if applicable). It is who do not meet formal diagnostic criteria for sexual dysfunction may possible to change a experience anxiety, fear, helplessness, or pain during sex. Survivors who Veteran’s response to the became involuntarily aroused in response to sexual stimulation during clinical reminder if he/she the assault may wonder if they actually enjoyed the experience. discloses MST at a later date. Difficulty identifying and setting appropriate interpersonal If in the healthcare provider’s boundaries. The profound violation of personal boundaries involved clinical opinion a given visit in sexual trauma may leave survivors confused about what is reasonable involved treatment for behavior in relationships. conditions related to the Risk of revictimization. Many of the behaviors survivors engage in to MST, this should be avoid trauma-related memories and feelings, such as substance abuse, indicated by checking the inattention to internal sensations and emotions, and dissociation, may MST checkbox on the unfortunately leave them susceptible to subsequent victimization. encounter form for the visit. It’s important to remember though that different sexual trauma survivors This notifies your facility’s may have very different reactions to their experiences. Gender, race/ billing office that the Veteran ethnicity, religion, sexual orientation, socioeconomic status and lifetime should not be charged for the trauma history are some factors that may have a powerful impact on a visit. survivor’s presentation. For More Information Visit the MST Resource Homepage (http://vaww.mst.va.gov) on the VA Intranet or speak with the MST Coordinator at your facility. March, 2011 .