Wounds Outside of Combat: Sexual Trauma in the Military

Sexual Violence: A Prevailing Issue

Sexual violence persists within all branches of the armed forces and in recent years, reports of sexual assault and harassment have garnered national attention. Sexual harassment and assault are also more prevalent within the military than in the majority of civilian organizations. While the armed forces progress in addressing this challenging issue, understanding sexual violence in a military context offers a lesser-known perspective on sexual trauma’s challenges.

In 2020, Fort Hood specialist Vanessa Guillen was assaulted and killed by a fellow soldier within her chain-of-command. This event was one of many that year that increased visibility on issues in the armed forces’ efforts against sexual violation. Even before Vanessa Guillen’s murder, the military was under pressure to improve their culture and overcome rampant reports of sexual assault. In 2004, a Department of Defense (DOD) task force aiming to provide resources to sexual assault survivors made recommendations for systematic changes to better support soldiers who experience sexual violence.[1] Those recommendations included developing a central point of accountability and a unified response system.[2] A year later, the military acknowledged that mandating commanders to be notified of crimes of sexual violence was a deterrent to soldiers who feared retaliation from their supervisors, peers, assailant (all of whom have the potential to be the same person) after reporting and removed this requirement.[3] The task force concluded their investigation by creating training on Sexual Assault Prevention and Response (SAPR) that has been led by the SAPR office, headquartered at the Pentagon. In the subsequent decades, the DOD and Department of Veteran Affairs have continued implemented several policies to improve treatment, clarify reporting procedures and provide long-term support to sexual assault victims.[4]

In 2022, public backlash over the discovery of murdered soldiers at Fort Cavazos, Texas spurred the military to add sexual harassment as a crime under the Uniform Code of Military Justice (UCMJ).[5] Still, despite decades of efforts against sexual violence, in the last two fiscal years research conducted by the Department of Veterans’ Affairs reported an increase of soldiers who filed unrestricted reports after being sexual assaulted and/or harassed. According to a fiscal year 2022 report submitted by the Pentagon, the rate of sexual assaults had risen 1% from the previous year.[6] Officials maintain that the increase of sexual assault reports is a positive step toward addressing the cultural problem because it implies that soldiers have less of a fear of retaliation or ostracization.[7] However, for service members, their families and future recruits, this increase potentially signals that the military is still searching for an enduring solution to the corrosive issue of sexual violence.[8] 

Defining Military Sexual Trauma (MST)

Military sexual trauma (MST) is a term used by the armed forces and Veterans Affairs (VA) to refer to sexual harassment and/or sexual assault that occurs in the military. According to the Department of Veterans Affairs, MST is specifically defined as: physical assault of a sexual nature, battery of a sexual nature, or sexual harassment (unsolicited verbal or physical contact of a sexual nature which is threatening in character) which occurred while the former member of the Armed Forces was serving on duty, regardless of duty status or line of duty determination.[9] Unlike other organizations, the VA extends the definition of MST to sexual harassment to encompass both physical and verbal instances of sexual encounters to which service members did not consent.

Specific examples include, but are not limited to:[10]

  • Being coerced or pressured into any kind of sexual activity (with the potential fear of negative repercussions if an individual does not consent, or promises any kind of advantage if they engage) 

  • Any form of physical contact or action without consent, including when a person is in a state that renders them completely incapable of communicating (e.g., sleeping, sick, intoxicated)

  • Being forced to engage in sexual activity through physical harm such as slapping, kicking, punching or assault with any form of a weapon

  • Being touched or grabbed in a sexual way during hazing or training

  • Any unwanted comments about a person’s body or sexual activities that they perceive to violate a personal boundary

  • Sexual advances that are spoken, gestured, sent through the phone or online

Like the DOD, the VA acknowledges sexual harassment with similar gravity to sexual assault, implementing resources such a hotline, victim advocates, and VA police for any individual who seeks resources or wishes to file a report.[11]

Common Symptoms Post-Trauma

After a sexually traumatizing event, veterans experience elevated rates of mental disorders, physical ailments, and difficulty building interpersonal relationships.

Specific impacts on health include:

Mental  

MST survivors have a high lifetime rate of post-traumatic stress disorder (PTSD) for both men at women, at 65% and 45% respectively.[12] Veterans who report MST and have PTSD are also likely to have comorbid major depression, anxiety, eating disorders, and substance use disorders. MST also exacerbates pre-existing mental health conditions, worsening the symptoms of conditions prior to the trauma-inducing event.[13]

Physical

Sexual difficulties, chronic pain and/or gastrointestinal disease are common physical health problems for service members recovering from sexual assault and/or harassment. [14] Survivors’ cognitive function is also impaired - many recovering service members report reduced ability to pay attention, concentrate and remember details.[15]

Interpersonal Relationships  

In some cases, veterans who experienced sexual abuse harbor trust issues and have problems engaging in social activities and intimacy. Struggling to progress out of isolation, many survivors also report difficulties finding or maintaining work after their military service.[16]

Prevalence of MST in Different Groups

Regardless of a person’s socioeconomic gender, ethnicity or identity there is still a chance that they are vulnerable to predatory behavior and sexual violence. Surveys indicate that 1% of active duty men and nearly 5% of active duty women are victimized in any given 12-month period.[17] In another study conducted in 2016, researchers from the University of Mary Washington compiled statistics on veterans reporting military sexual trauma across the following databases: PsycINFO, PubMed, and PILOTS.[18] The results revealed that 15.7% of current military personnel and veterans report MST when the measure includes both harassment and assault.[19] Additionally, 13.9% report MST when the measure assesses only assault and 31.2% report MST when the measure assesses only harassment.[20] Across all military branches MST was significantly higher among veterans who reported using VA healthcare services.[21]

Women

Women are significantly more likely to experience and report MST than their male counterparts.[22] Roughly one-in-three women veterans have told their VA health care provider they experienced sexual harassment or assault while in the military.[23] Women with MST also have higher rates of PTSD than those with other traumas: 60% and 43%, respectfully.[24]

Men

Contrary to common misconceptions, men are also victims of sexual violence. Male service members have a 3.9% likelihood of reporting abuse when the measure includes both harassment and assault, and a 1.9% likelihood when the measure assesses only assault. Fearing judgment and alienation, male victims underreport sexual assault and/or harasment; Rossellini et al. (2017) note the true number of such men might exceed that of women, as men have a much lower rate of reporting to authorities than their female counterparts.[25] 

Ethnic Minorities

Ethnic minorities (particularly women of color) experience MST at greater levels than their Caucasian counterparts, with research conducted in 2023 at Washington University in St. Louis revealing that 21% of ethnic minority female veterans compared with 1% of ethnic minority male veterans have experienced MST.[26] Black women are also the most-likely to delay disclosure of MST.[27]

LGBTQ+

Research at Washington University in St. Louis also discovered that while non-LGBTQ service members report MST at a rate of 14%, those identifying as sexual minorities report MST at nearly twice the rate at 26%.[28] Experiencing the greatest rate of sexual harassment/assault, nearly 1-in-3 transgender service members (30%) report MST. 

Other Demographics

In a 2022 study conducted at Pennsylvania University, researchers found that those who experienced adversity or trauma during childhood were more likely to experience Military Sexual Trauma (MST) during their service (Auman-Bauer 2022).[29]

Other factors that exacerbate a person’s potential to be sexually assaulted or harassed in the military include:

  • Age/young adults

  • Having a low level of education

  • Being unmarried

  • Having a lower rank

  • Being within their first contract of recently entered service         

Post-Trauma Care & Recovery

Peer support has emerged as a form of treatment that mitigates symptoms of loneliness and isolation, and is a common example of clinical care and support during an MST survivor’s journey through recovery. Organizations like the Women Veterans Network (WoVeN) and Veterans Sisters are examples of peer support with the mission to increase community and connection and provide resources for women veterans.

Penn State University researchers who identified the connection between MST and previous combat experience and childhood trauma propose screening service members prior to leaving the military in order to try to determine how to best treat them.[30] Under this proposal, the military hands the patients’ information off to the VA, to then provide specific trauma-informed care to service members who have experienced trauma as they transition out of active-duty.[31]

The mobile app Beyond MST provides self-help tips, assessments, and skills-based tools to support the health and well-being of MST survivors. Designed by the VA, this app comes at no cost, does not disclose a person’s personal information, and helps service members regain hope and heal.[32]

Post-MST Psychotherapy

The Veterans Affairs Office of Research and Development conducted a study in 2006 to determine which treatment methods were most effective in treating post-MST symptoms.[33] As the researchers determined, treating sexual violence in military settings is unique and departs from clinical approaches to civilian sexual trauma for two reasons: veterans with MST are likely violated by trusted military personnel and victims are often without access to immediate treatment.[34] Although MST treatments continue to evolve, effective therapies include Cognitive Behavorial Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and narrative therapy. In certain instances, psychiatrists also prescribe anti-anxiety medication and/or anti-depressants.[35]

Brothers in Arms? Regaining Trust in the Military

As the armed forces continue to work to appeal to a younger generation, the slow improvement with addressing sexual assault has the potential to impact the number and diversity of recruits. In 2021 Secretary of Defense General (Gen.) Lloyd Austin established the Independent Review Commission on Sexual Assault in the Military to improve efforts in accountability, prevention, and victim care.[36] After receiving the commission’s results, Gen. Austin accepted every proposed policy change, and later remarked, “These investments are pivotal to restore the trust of our service members, as well as those considering military service.”[37] The accepted changes include increasing workers within the sexual assault response workforce, including victim advocates and sexual assault response coordinators.

Still, the military has added work to do before it fully controls the sexual assault and harassment within its ranks. In 2013, the investigative documentary The Invisible War earned critical and commercial success for shedding light on the pervasive issue of sexual assault in every military branch.[38] Featuring stories from over 25 soldiers, the documentary was groundbreaking in its final message: a female soldier in combat zones is more likely to be raped by a fellow soldier than killed by enemy fire.[39]

Although the film was made over a decade ago, this statistic still stands, and the victims of sexual assault carry symptoms of PTSD, agoraphobia, and depression - much like their counterparts who endured combat. According to the Rape, Abuse and Incest National Network, these destructive long-term physical, psychological, and social effects of sexual violence on the victims cannot be underestimated, and as veterans integrate into the civilian world, mental illnesses put them at higher risks of homelessness, unemployment, and suicide.[40] Leaders in and outside of the military continue to gain awareness into the emotional and mental impacts of sexual violence. However, the military must not only attempt to eliminate sexual violence by developing new policies and regulations - it must also address the intangible part of its culture that has allowed this violence to persist.

Contributed by: Kate Campbell

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Department of Defense. Task Force Report on Care for Victims of Sexual Assault. National Center on Domestic and Sexual Violence Website. http://www.ncdsv.org/images/DOD_TaskForceReportOnCareForVictimsOfSexualAssault_4-2004.pdf

2 National Resource Center on Domestic Violence (NRCDV). (2021). Sexual violence in the military. NRCDV Website. https://vawnet.org/sc/sexual-violence-military-0

3 Ibid.

4 Ibid.

5 Chappell, B. (2022, January 27). Vanessa Guillen’s murder led the U.S. to deem military sexual harassment a crime. National Public Radio Website. https://www.npr.org/2022/01/27/1076143481/vanessa-guillen-murder-military-sexual-harassment-crime

6 Ware, D. (2023, April 28). Reports of sexual assaults increased in the Navy, Air Force, and Marines in 2022; Army saw a decline. American Legion Website. https://www.legion.org/news/258848/reports-sexual-assaults-increased-navy-air-force-and-marines-2022-army-saw-decline#:~:text=There%20were%208%2C942%20reports%20of,slight%20increase%20from%20last%20year

7 Ibid.

8 U.S. Department of Defense. (2022, September 2). DOD takes measures as sexual assault annual report numbers released. U.S. Department of Defense Website.https://www.defense.gov/News/News-Stories/Article/Article/3148495/dod-takes-proactive-measures-as-sexual-assault-annual-report-numbers-released/

9  U.S. Congress. (2004). United States Code: Uniform Code of Military Justice, 38 USC 1720D: Counseling and treatment for sexual trauma. Retrieved from the Library of Congress, https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1720D&num=0&edition=prelim

10 U.S. Department of Veterans Affairs. (2023, May 18). Military Sexual Trauma. U.S. Department of Veterans Affairs Website. https://www.mentalhealth.va.gov/msthome/index.asp

11 U.S. Department of Veterans Affairs. (2022, December 12). VA’s Anti-Harassment and Anti-Sexual Assault Policy. U.S. Department of Affairs Website. https://www.va.gov/stop-harassment/policy/

12 Disabled American Veterans (DAV). (2023). What is Military Sexual Trauma? DAV Website. https://www.dav.org/get-help-now/veteran-topics-resources/military-sexual-trauma-mst/

13 Ibid.

14 Ibid. 

15 Ibid.

16 Ibid.

17 Bicksler, B., Farris, C., Ghosh-Dastidar, B., Jaycox, L.H., Kilpatrick, D., Kistler, S., Street, A., Tanielian, T., Williams, K.H. (2014).Sexual Assault and Sexual Harassment in the U.S. Military. Rand Corporation Website. https://www.rand.org/pubs/research_reports/RR870z2-1.html

18 Wilson L. C. (2018). The Prevalence of Military Sexual Trauma: A Meta-Analysis. Trauma, violence & abuse, 19(5), 584–597. https://doi.org/10.1177/1524838016683459

19 Ibid.

20 Ibid.

21 Barth, S. K., Kimerling, R. E., Pavao, J., McCutcheon, S. J., Batten, S. V., Dursa, E., Peterson, M. R., & Schneiderman, A. I. (2016). Military Sexual Trauma Among Recent Veterans: Correlates of Sexual Assault and Sexual Harassment. American journal of preventive medicine, 50(1), 77–86. https://doi.org/10.1016/j.amepre.2015.06.012

22 Wilson (2018)

23 Rosellini, A. J., Street, A. E., Ursano, R. J., Chiu, W. T., Heeringa, S. G., Monahan, J., Naifeh, J. A., Petukhova, M. V., Reis, B. Y., Sampson, N. A., Bliese, P. D., Stein, M. B., Zaslavsky, A. M., & Kessler, R. C. (2017). Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army. American journal of public health, 107(5), 732–739. https://doi.org/10.2105/AJPH.2017.303693

24 Yaeger, D., Himmelfarb, N., Cammack, A., & Mintz, J. (2006). DSM-IV diagnosed posttraumatic stress disorder in women veterans with and without military sexual trauma. Journal of general internal medicine, 21 Suppl 3(Suppl 3), S65–S69. https://doi.org/10.1111/j.1525-1497.2006.00377.x

25 Rosellini, A. J., Street, A. E., Ursano, R. J., Chiu, W. T., Heeringa, S. G., Monahan, J., Naifeh, J. A., Petukhova, M. V., Reis, B. Y., Sampson, N. A., Bliese, P. D., Stein, M. B., Zaslavsky, A. M., & Kessler, R. C. (2017). Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army. American journal of public health, 107(5), 732–739. https://doi.org/10.2105/AJPH.2017.303693

26 Barth, S. K., Kimerling, R. E., Pavao, J., McCutcheon, S. J., Batten, S. V., Dursa, E., Peterson, M. R., & Schneiderman, A. I. (2016). Military Sexual Trauma Among Recent Veterans: Correlates of Sexual Assault and Sexual Harassment. American journal of preventive medicine, 50(1), 77–86. https://doi.org/10.1016/j.amepre.2015.06.012

27 Goldbach, J. T., Schrager, S. M., Mamey, M. R., Klemmer, C., Holloway, I. W., & Castro, C. A. (2023). Development and Validation of the Military Minority Stress Scale. International journal of environmental research and public health, 20(12), 6184. https://doi.org/10.3390/ijerph20126184

28 Ibid.

29 Ibid.

30 Bauer, K.A. (2022, August 24). Military sexual trauma more likely among veterans with prior adversity, trauma. Social Science Research Institute at the University of Pennsylvania Website. https://www.psu.edu/news/social-science-research-institute/story/military-sexual-trauma-more-likely-among-veterans-prior/

31 Ibid.

32 Galovski, T. E., Street, A. E., Creech, S., Lehavot, K., Kelly, U. A., & Yano, E. M. (2022). State of the Knowledge of VA Military Sexual Trauma Research. Journal of general internal medicine, 37(Suppl 3), 825–832. https://doi.org/10.1007/s11606-022-07580-8

33 Goldbach et. al (2023)

34 Suris, A.M. (2006). Treatment for veterans with military sexual trauma. VA Office of Research and Development. https://classic.clinicaltrials.gov/ct2/show/NCT00371644#contactlocation

35 Ibid.

36 U.S. Department of Defense. (2022, September 2). DOD Takes Proactive Measures as Sexual Assault Annual Report Numbers Released. Department of Defense Website. https://www.defense.gov/News/News-Stories/Article/Article/3148495/dod-takes-proactive-measures-as-sexual-assault-annual-report-numbers-released/

37 United States Air Force. (2022, September 5). DOD Takes Proactive Measures as Sexual Assault Annual Report Numbers Released. United States Air Force Website. https://www.aflcmc.af.mil/NEWS/Article-Display/Article/3149016/dod-takes-proactive-measures-as-sexual-assault-annual-report-numbers-released/

38 Huval, R.I. (2013, May 10). Sen Kristen Gillibrand credits The Invisible War with shaping new bill. Public Broadcasting Station Website. https://www.pbs.org/independentlens/blog/sen-gillibrand-credits-the-invisible-war-in-shaping-new-bill/

39 Ibid.

40 Thurston, A. (2022, November 9). Why veterans remain at greater risk of homelessness. The Brink, pioneering research from Boston University Website. https://www.bu.edu/articles/2022/why-veterans-remain-at-greater-risk-of-homelessness/