Military Sexual Trauma: Current Knowledge and Future Directions
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.