Military sexual trauma: How to identify and treat a unique form of PTSD
Sexual trauma may cause or exacerbate posttraumatic stress disorder (PTSD).See "Traumatized Troops: How to treat combat-related PTSD"). Two recommended questions (Box) for men and women can help you start discussing MST.
Use compassion and sensitivity, recognizing the stigma of sexual assault while fastidiously preserving confidentiality. Establish a comfortable environment for disclosure, be nonjudgmental, and maintain good eye contact as you gradually introduce the questions.
How to screen veterans for military sexual trauma (MST)
The National Center for Posttraumatic Stress Disorder (Related resources) suggests two screening questions for MST:
- While you were in the military, did you experience any unwanted sexual attention, such as verbal remarks, touching, or pressure for sexual favors?
- Did anyone ever use force or threat of force to have sex with you against your will?
Comprehensive MST management includes assessing for PTSD, major depression, and substance abuse. When a veteran screens positive for MST, validation and empathy are first-line treatment. Provide MST education, assess health status, and ask them about their support systems.
Sexual trauma survivors often suffer low selfesteem, self-blame, anger, difficulties with interpersonal relationships, and sexual dysfunction. “PTSD flare-ups” can occur during medical encounters and clinical procedures. Evaluate MST survivors regularly for re-victimization, as they may be at risk to be sexually abused again outside the military.5
Referral. Consider referring veterans to a local VA facility, which all have a “military sexual trauma coordinator” to help veterans obtain treatment. Other VA resources include referrals to the women veterans program manager or mental health clinic.
Veterans living in the community can be referred to readjustment counseling service offices, which have sexual trauma counselors on staff. This may be an option for the veteran who does not want to obtain mental health services from the VA.
- Street A, Stafford J. Military sexual trauma: Issues in caring for veterans. National Center for Posttraumatic Stress Disorder. www.ncptsd.org//war/military_sexual_trauma.html.
1. Kang H, Dalager N, Mahan C, et al. The role of sexual assault on the risk of PTSD among Gulf War veterans. Ann Epidemiol 2005;15(3):191-5.
2. Bastian L, Lancaster A, Reyst H. Department of Defense 1995 Sexual Harassment Survey (Report No. 96-014). Arlington, VA: Defense Manpower Data Center; 1996.
3. Department of Veterans Affairs. Report to Congress on the Study of Sexual Trauma among Reservists on Active Duty for Training. According to documents provided March 30, 2006 by the Subcommittee on Health, Committee of Veterans’ Affairs, U.S. House of Representatives.
4. Street A, Stafford J. Military sexual trauma: Issues in caring for veterans. National Center for Posttraumatic Stress Disorder. Available at: http://www.ncptsd.org//war/military_sexual_trauma.html. Accessed March 13, 2006.
5. Carole T, Susane F (eds). Military sexual trauma: Veterans Health Initiative, Department of Veterans Affairs. 2004;77-83.Available at: https://www.ees-learning.net/librix/loginhtml.asp?v=librix. Accessed March 28, 2006.