1. Combat: Unique Issue

2. Stressor-related Factors Unique characteristics of a traumatic event that play a role in shaping post-traumatic functioning These factors may overlap with other traumatic events

3. Combat-Related Stressors Type of combat plays an important role in shaping the response Afghanistan and Iraq are the most sustained combat operations since Vietnam Increased frequency and intensity of combat exposure

4. Combat-Related Factors contd. Persistent danger of guerilla warfare and terrorist activities Difficulty determining ‘who is the enemy’ Prolonged periods of vigilance Rules of engagement that prohibit engaging in spite of the fact that the situation is threatening Ongoing stress and strain

5. Combat-Related Factors contd. High casualty rates (now exceed 4000) High ratio of wounded to killed so many are exposed to wounded comrades and to seeing their comrades killed See high rates of civilian casualties including those of women and children Moral conflict of killing others, including unintended death of civilians

6. Meaning of War As the war continues, public support for the war wanes and can affect the perceived support of the service members; No available research on this topic

7. What is Military Sexual Assault (MSA)? Sexual assault that occurs in the military setting Victims and perpetrators can be male or female

8. How is MSA Different from Other Types of Sexual Assault? Military sexual assault occurs in a setting where the victim lives and works, and as a consequence: –Victim may rely on perpetrator for basic needs –Career goals may be disrupted –Victim may experience increased feelings of powerlessness Anecdotal evidence suggests MSA may be underreported because of fear that: –Report will be ignored –Survivor will be blamed for the assault –There will be negative implications for career

9. Prevalence of MSA In 1995, the Department of Defense conducted a study of active duty military members. Findings from this study indicated that in the previous year, MSA had affected: –6% of women –1% of men

10. In a study of female VA healthcare users conducted in 1997: 23% reported MSA at some time during their military service MSA was related to a number of health outcomes, among them: –Mental health problems, including PTSD, depression, and anxiety –Gastrointestinal and pulmonary problems –Chronic fatigue, vision, and hearing problems –Dissatisfaction with sex life (Skinner et al., 2000) Consequences of MSA

11. Sexual Assault and PTSD among Returning Iraq and Afghanistan War Veterans Reports of sexual harassment and assault perpetrated by fellow military personnel, military leaders, allies, and foreigners have surfaced in the media (Loeb, 2004; Martineau & Wiegand, 2005; “Sexual assaults,” 2005; Siemaszko, 2005) Military members may be coping with additional deployment stressors, in addition to MSA, that increase the risk for negative health consequences –Lack of social support (Vogt, Pless, King, & King, 2005) –Family stress (Blount, Curry, & Lubin, 1992) –Combat and other war-zone stressors (Ritchie, 2001)

12. Screening for Military Sexual Trauma Military sexual trauma refers to both sexual harassment and assault experienced during military service VA mandates universal screening for military sexual trauma Important elements of the screening process include: –Establishing a comfortable climate for disclosure –Deciding on how screening will be conducted (e.g., as part of social history or on an intake form) –Introducing the line of questioning in a non-judgmental manner –Asking behaviorally-based questions (e.g., Did someone ever use force or the threat of force to have sexual contact with you against your will? [sexual assault])

13. Screening for Military Sexual Trauma in the VA (cont.) Response to disclosure of military sexual trauma should include: –Validation/empathy –Education about post-trauma reactions –Assessment of current health and safety status –Assessment of support available to individual All patients with a sexual trauma history should be offered the option of a mental health referral

14. When making referral, it is important that the clinician know: –How to present the referral in a way that will maximize its acceptability to patient Normalize experience Offer options –Where to send the consult Local VA’s Military Sexual Trauma Coordinator Women Veterans Program Manager Mental Health (For more information, please see the Military Sexual Trauma Quick Reference Guide available through the Employee Education System) Screening for Military Sexual Trauma in the VA (cont.)