Military Sexual Trauma MST

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Military Sexual TraumaMST

• Wounds of War Conference
• Diane T. Castillo, Ph.D.
• Coordinator, WSDTT
• February 6, 2008

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Overview

• Definitions
• Diagnoses and Statistics
• Effective Treatments

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MST Mandate in VA System

• Public Law 102-585 Mandated outreach and
  counseling
• Public Law 103-452 MST counseling to men as
  well as women
• Public Law 106-177 Veterans Millennium Health
  Care Act
• Above laws require assessing and treating all
  veterans with MST

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Definitions by VA

• When you were in the military, did you ever
  receive uninvited or unwanted sexual attention
  (i.e., touching, cornering, etc.)?
• or
• When you were in the military did anyone use
  force or the threat of force to have sex against
  your will?

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Standard Definitions

• Sexual Harassment-Repeated, unsolicited, verbal
  or physical contact of a sexual nature
• Sexual Assault-Actual sexual contact through the
  use of threat, non-consensual
• Rape-Non-consensual sexual penetration through
  use of force
• Abuse-Intentionally caused or attempted bodily
  injury or apprehension of injury

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Common Signs of Sexual Abuse

• Depression
• Anxiety
• Sleep Difficulties
• Alcohol/SA
• Somatic Complaints

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Most Common Diagnosis Post traumatic Stress
Disorder--PTSD

• Trauma
• 3 Categories of Symptoms
• Reexperiencing
• Avoidance/Numbing
• Hyperarousal
• Symptoms last more than 1 month

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Trauma

• The person has been exposed to a traumatic event
  in which both of the following were present
• The person experienced, witnessed, or was
  confronted with an event or events that involved
  actual or threatened death or serious injury, or
  a threat to the physical integrity of self or
  others
• The persons response involved intense fear,
  helplessness, or horror.

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PTSD Symptom Categories

• Reexperiencing (min. of 1)
• Intrusive recollections
• Nightmares
• Flashbacks
• Psychological distress with reminders
• Physiological reaction to reminders
• Avoidance/Numbing (min. of 3)
• Avoidance of thoughts, feelings
• Avoidance of reminders
• Social isolation
• Feelings of detachment from others
• Reduction of emotions (positive)
• Sense of foreshortened future

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PTSD Symptom Categories (cont.)

• Hyperarousal (min. of 2)
• Sleep difficulties
• Irritability and/or anger outbursts
• Poor concentration
• Exaggerated startle response
• Hypervigilence

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Demographics (N236)

• Mean Age49.9, SD10.4
• 77 Veteran, 20 ChampVA, 3 AF
• 43 Army, 29 AF, 22 Navy, 3 Marine Corps
• 14 OIF/OEF veterans
• 60 white, 26 Hispanic 9 African American, 3
  Native American, 2 other
• 42 married, 29 divorced, 26 never married

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Demographics (cont.)

• 72 sexual trauma, 8 other, 20 combo
• 28 childhood trauma, 31 adult, 41 both
• 69 diagnosed with PTSD another diagnosis (31
  PTSD only)
• 84 more than one trauma

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Percentages of MST in VA System
Males Females Total
YesReports MST 2,718 (1.2) 2,952 (23.2) 5,670 (2.3)
NoDoes Not Report MST 232,907 12,724 245,631
ScreenedDeclined to Answer 1,764 269 2,033
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Treatment for PTSD at Alb. VA

• Trauma clinic for mennot just for combat-related
  trauma
• Womens Stress Disorder Treatment Teammilitary/
  childhood/other adult rape other traumas
• Both programs offer individual and group
  counseling as well as medication
  evaluation/management

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Womens Stress Disorder Treatment Team (WSDTT)

• Staff
• Two f/t psychologists
• One f/t social worker
• One h/t psychiatrist
• One h/t nurse clinical specialist

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WSDTT Program Components

• Assessment
• Initial Interview
• Psychological Testing (MMPI, MCMI, BDI, BUSS)
• CAPSClinician Administered PTSD Scale

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• Treatments Groups, Individual, Medication
• Core Groups
• PsychEd (intro)
• Cognitive Processing
• Skills
• Sexual Intimacy
• Focus (exposure therapy)
• Most effective for PTSD

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Assessment Data

• CAPS
• Current M73.8, SD27.7
• Lifetime M104.9, SD24.7
• MMPI2
• Peaks on F(86.8), 2(78.5), 8(82.5), PK(79.2),
  and PS(79.3)
• MCMI2
• Peaks on Schizoid and Avoidant scales (BRgt80).
• BDI M24.7, SD11.9

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Outcome Data with PCL

• Focus--Sig. improvement on
• Overall PTSD
• Avoidance/ Numbing
• Cognitive--Sig. improvement on
• Overall PTSD
• Avoidance/Numbing
• Hyperarousal
• Skills--Sig. improvement on
• Avoidance/ Numbing
• Sexual Intimacy No sig. improvement in PTSD

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Conclusion

• MST is priority for VA in assessing for and
  treating male and female veterans
• MST can result in variety of symptoms,
  particularly PTSD
• Effective treatments are available for treating
  PTSD and are available at VA