Military Sexual Trauma: Current Knowledge and Future Directions

Carolyn Allard, Melissa Platt

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317977711
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Military Sexual Trauma: Current Knowledge and Future Directions showcases the work of several prominent military sexual trauma (MST) researchers, scholars, and clinicians from across the United States. A review of existing research and original empirical findings converge to indicate that MST contributes to a range of physical health problems, complex posttraumatic responses, and other mental health consequences above and beyond the effects of other types of traumatic experiences. This collection also presents evidence suggesting that MST is often difficult to identify both within the individual military member and within the military population as a whole. Recommendations are offered for addressing this problem. In addition to the research review and empirical findings, an evolutionary framework for understanding sexual assault of women in the military is presented. Taken together, this collection of works may inform MST intervention and prevention efforts.

This book was originally published as a special issue of Journal of Trauma & Dissociation.

Introduction

Melissa Platt, MA, MS

Department of Psychology, University of Oregon, Eugene, Oregon, USA

Carolyn B. Allard, PhD

Psychology Service, Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of California, San Diego, California, USA

Until recently, the study of psychological effects of military trauma has focused nearly exclusively on the consequences of combat-related stressors such as being in the line of fire, experiencing an explosion, or suffering a physical injury. Meanwhile, sexual trauma has primarily been recognized in the forms of childhood or adult civilian abuse. Combat-related distress has largely been investigated among men, whereas sexual assault research has focused on women. As military sexual trauma (MST) bridges the gap between traumatic events historically divided between military and civilian and also between events traditionally categorized as happening to men versus women, its recognition may potentially represent a turning point in the field of traumatic stress.

One of the aims we had in putting together this special issue was to provide MST researchers and clinicians with a summary of the state of MST research and a collection of some of the most up-to-date MST-related investigations representative of the directions in which this research is heading. This collection is by no means exhaustive. Many other important submissions could not be included in this special issue because of space limitations. Another aim was to facilitate continued research efforts by elucidating the gaps in the extant MST research, presenting important lines of research that have begun, and proposing new areas of research that may have important implications for efforts toward preventing MST and reducing its aftermath.

The first set of papers in this special issue suggest a need for increased standardization in the study of MST prevalence and greater attention to individual differences, population selection, and measurement issues. As Allard, Nunnink, Gregory, Klest, and Platt (this issue) report, although most of what is known about MST relates to prevalence and health correlates, a high degree of unreliability in prevalence data persists. As noted by Murdoch and colleagues (this issue), the military’s “gold standard” assessment of MST was normed on college-educated women and thus does not reliably capture MST rates in men or individuals without at least a college education. Hoyt, Rielage, and Williams (this issue) remind the reader that the majority of MST incidents involving male victims are not reported. Valdez and colleagues (this issue) present findings indicating that victims of MST may be overrepresented not only in posttraumatic stress disorder treatment settings but also in psychosocial rehabilitation centers and substance use treatment settings.

Despite the difficulties in assessing the absolute prevalence of MST, it is clear that it is experienced by a substantial number of women and men, with devastating outcomes. Empirical work presented in this issue demonstrates that MST is linked not only with symptoms of posttraumatic stress disorder but also with more complex posttraumatic reactions, including difficulties with interpersonal relationships, emotion regulation, dissociation, somatization, and self-perception (Luterek, Bittinger, & Simpson, this issue), increased pain-related physical health problems (Smith et al., this issue), and higher rates of trading sex (Strauss et al., this issue). What is more, these latest findings add to existing evidence, summarized in this issue by Allard and colleagues, that MST is associated with greater posttraumatic difficulties compared to other potentially traumatic experiences, including combat experiences and adult and civilian sexual abuse. Like combat trauma, MST often strips victims of their sense of safety and competence. However, unlike the MST victim, the victim of combat trauma may rely on the support of unit members and a sense of shared experience in order to cope. As noted by many of the authors in this special issue, MST is frequently accompanied by expectations of silence. Empirical study of the effects of institutional silencing and other factors purported to put MST survivors at increased risk for posttraumatic distress relative to other types of trauma is called for.

MST prevention research is equally sparse, as Allard and colleagues’ (this issue) review reveals. Potentially informative to prevention efforts is Hannagan and Arrow’s (this issue) evolutionary framework for understanding the sexual assault of women in the military, which is based on their review of theory and research in evolutionary principles, group and war psychology, and MST case studies. Their framework provides a guide for future research and cultural-level interventions aimed at the prevention of MST. Empirical evidence of treatment effectiveness for MST-related distress is also limited (see Allard et al., this issue). As MST involves the unique stressors associated with a war zone environment and those associated with interpersonal betrayal, existing intervention efforts based on other types of traumatic experiences must be systematically empirically evaluated prior to their implementation with MST survivors.

We hope this special issue provides an impetus for increased research aimed at assessing the effectiveness of current treatments in MST populations, development of treatments that can address the myriad difficulties associated with MST, and increasing access to effective treatments for individuals experiencing distress related to MST. Some authors in the current issue offer recommendations for increasing access. Valdez and colleagues recommend resource allocation to settings where MST is overreported, including settings with high rates of MST among men. Hoyt et al. recommend MST screenings in medical settings in order to provide a safe space for disclosure among male veterans who may be avoiding mental health treatment settings.

Taken together, the findings presented in this special issue suggest that more work is needed in order to increase the reliability of MST prevalence estimates; illuminate the reasons why MST’s adverse impact exceeds that of other types of traumatic experiences; better understand the male experience of MST; and inform and test prevention and intervention efforts at the individual, group, and institutional levels. Recent advances in MST awareness, including universal Veterans Health Administration screening, have made possible much of the research conducted on MST, including the publication of the important articles in this special issue. It is our hope that ongoing Veterans Health Administration support and the kinds of research efforts showcased in this collection will provide momentum for additional progress through systematic investigations of MST prevalence, prevention, and treatment outcomes to continue to inform and advance the field of traumatic stress.

Unreliability and Error in the Military’s “Gold Standard” Measure of Sexual Harassment by Education and Gender

Maureen Murdoch, MD, MPH

Center for Chronic Disease Outcome Research, Department of Medicine, Minneapolis VA Medical Center, and Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA

John B. Pryor, PhD

Department of Psychology, Illinois State University–Normal, Normal, Illinois, USA

Joan M. Griffin, PhD

Center for Chronic Disease Outcome Research, Department of Medicine, Minneapolis VA Medical Center, and Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA

Diane Cowper Ripley, PhD

HSR&D/RR&D Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA

Gary D. Gackstetter, PhD, MPH, DVM

Analytic Services, Inc. (ANSER), Arlington, Virginia; and Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

Melissa A. Polusny, PhD

Center for Chronic Disease Outcome Research, Departments of Psychology and Psychiatry, Minneapolis VA Medical Center, and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA

James S. Hodges, PhD

Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA

The Department of Defense’s “gold standard” sexual harassment measure, the Sexual Harassment Core Measure (SHCore), is based on an earlier measure that was developed primarily in college women. Furthermore, the SHCore requires a reading grade level of 9.1. This may be higher than some troops’ reading abilities and could generate unreliable estimates of their sexual harassment experiences. Results from 108 male and 96 female soldiers showed that the SHCore’s temporal stability and alternate-forms reliability was significantly worse (a) in soldiers without college experience compared to soldiers with college experience and (b) in men compared to women. For men without college experience, almost 80% of the temporal variance in SHCore scores was attributable to error. A plain language version of the SHCore had mixed effects on temporal stability depending on education and gender. The SHCore may be particularly ill suited for evaluating population trends of sexual harassment in military men without college experience.

Sexual harassment, reported by up to 74% to 80% of active duty men and women (Bastian, Lancaster, & Reyst, 1996; Rosen & Martin, 1998), has been associated with symptoms of depression, anxiety, and posttraumatic stress disorder (e.g., Kang, Dalager, Mahan, & Ishii, 2005); diminished job satisfaction and performance; and even poorer nonwork interpersonal relationships (Pryor, 1995). Progress in reducing military sexual harassment has primarily been gauged by periodically surveying troops and comparing their reports of sexual harassment to those of previously surveyed troops. However, earlier sexual harassment surveys yielded widely differing prevalence estimates across service branches, primarily because each branch defined and measured sexual harassment differently. Consequently, in 1998 the Deputy Assistant Secretary of Defense for Equal Opportunity mandated the development of a standardized sexual harassment instrument that was to be “used in all [Department of Defense] and Service-wide surveys” (Lipari & Lancaster, 2003, p. 97). The military’s chosen measure, the Sexual Harassment Core Measure (SHCore; Stark, Chernyshenko, Lancaster, Drasgow, & Fitzgerald, 2002), is a 12-item derivative of the Sexual Experiences Questionnaire (SEQ; Fitzgerald et al., 1988).

The SEQ was developed primarily in college students and faculty (Fitzgerald et al., 1988; Gelfand, Fitzgerald, & Drasgow, 1995), and most of its psychometric evaluation has been conducted in women (Fitzgerald, Gelfand, & Drasgow, 1995; Gelfand et al., 1995). In the armed forces, however, men outnumber women by a ratio of 6:1. Yet most psychometric evaluation of the Department of Defense’s SEQ version has either excluded men or, when men were included, evaluated only a subset of the SEQ items they responded to (Fitzgerald, Magley, Drasgow, & Waldo, 1999). The SEQ/SHCore’s performance in military men therefore remains uncertain.

Furthermore, perhaps because the SEQ was developed in college populations, it and the SHCore require relatively high reading grade levels of 9.8 and 9.1, respectively, based on the Flesch-Kincaide readability formula (Kincaid, Fishburne, Rogers, & Chisson, 1975). Because military recruits have on average an 11th-grade reading proficiency—which is higher than that of the general U.S. population—most military members would likely find the SHCore reasonably straightforward and easy to read. However, a substantial fraction with below-average reading skills might struggle to comprehend it. For example, approximately 10% of military troops have not completed high school, and about a third have cognitive aptitude scores between the 30th and 50th percentiles of national norms (Department of Defense, 2004). Consequently, many military training materials are targeted to a 5th- or 6th-grade reading level, which is the level literacy experts recommend to ensure comprehension of printed materials (Doak, Doak, & Root, 1996).

As with training materials, survey instruments need to perform adequately at all levels of reading comprehension. Otherwise, common results include low survey returns and more satisficed responses. Low response rates have been previously reported in military studies using the SHCore (Bastian et al., 1996), but no study has evaluated possible satisficing. “Satisficed” responses are the opposite of “optimized” responses and occur when survey respondents do not carefully and accurately interpret questions, do not fully develop an accurate summary judgment in response to questions, or do not transcribe their judgments correctly (Krosnick, 1991). They are responses that, on the face of it, appear valid but do not actually convey accurate information. Examples of extreme satisficing include endorsing the same response to every item regardless of the item content or randomly endorsing various responses for different items.

Satisficing has also been linked to poor motivation (Krosnick et al., 2002; Lam & Bengo, 2003). Military men, who generally face lower risks for sexual harassment than military women (Bastian et al., 1996; Culbertson, Rosenfeld, & Newell, 1993; Lipari & Lancaster, 2003), could be less motivated than women to respond accurately to sexual harassment questions. Furthermore, some critics have questioned the applicability and saliency of the various versions of the SEQ to men, arguing that several types of experiences important to them, such as challenges to one’s masculinity, are not captured (Berdahl, Magley, & Waldo, 1996; Waldo, Berdahl, & Fitzgerald, 1998).

Whether arising from comprehension problems or low motivation, satisficed responses may increase both random and systematic measurement error (Krosnick, 1991; Krosnick et al., 2002). This in turn could cause investigators to over- or underestimate the prevalence of military sexual harassment in selected subgroups and could hinder the appropriate allocation of resources to those subgroups (e.g., to prevent the occurrence of sexual harassment or its sequelae). In addition to possible differences in sexual harassment reporting by gender, for example, satisficing could plausibly account for some of the inverse association described between years of formal education and reporting sexual harassment (Antecol & Cobb-Clark, 2006). Clarifying the SHCore’s performance in groups at higher risk for satisficing is therefore important.

Because the SHCore was derived from a scale developed primarily in female college populations, we hypothesized t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• 1. Introduction
• 2. Unreliability and Error in the Military’s “Gold Standard” Measure of Sexual Harassment by Education and Gender
• 3. Veterans Health Administration Mental Health Treatment Settings of Patients Who Report Military Sexual Trauma
• 4. Military Sexual Trauma in Men: A Review of Reported Rates
• 5. Posttraumatic Sequelae Associated with Military Sexual Trauma in Female Veterans Enrolled in VA Outpatient Mental Health Clinics
• 6. Posttraumatic Stress Symptomatology as a Mediator of the Association Between Military Sexual Trauma and Post-Deployment Physical Health in Women
• 7. Is Military Sexual Trauma Associated with Trading Sex Among Women Veterans Seeking Outpatient Mental Health Care?
• 8. Reengineering Gender Relations in Modern Militaries: An Evolutionary Perspective
• 9. Military Sexual Trauma Research: A Proposed Agenda
• Index