BALTIMORE -- Male veterans who have a history of military sexual trauma often fail to disclose their condition until well into treatment for posttraumatic stress disorder and have many motivations for covering up their problem, according to speakers at the annual meeting of the International Society for Traumatic Stress Studies.
Another complication is that few clinicians know of community resources to whom to refer male military sexual trauma (MST) patients, said Ilona L. Pivar, Ph.D., of the National Center for Posttraumatic Stress Disorder in the Veterans Affairs Palo Alto (Calif.) Health Care System.
"I speak from experience because of the difficulty getting referrals [and] the difficulty educating providers that this is a problem and that I am there as a resource for referrals," Dr. Pivar said.
Other contributing factors to the low awareness of MST among men include shame and stigma, and resistance to being labeled or targeted as a victim of MST. These are perpetuated by myths about male sexual assault, such as the notion that males cannot be raped, sexual assaults against men happen only in prison, male adult victims must be homosexual, heterosexual males do not rape men, and males are less affected by sexual assault than are females.
"I have veterans who I've treated who do not want to have that box in the VA system checked 'MST,' and they don't have it [checked]; however, they have MST and they have PTSD," she said. "Their initial treatment in the military may have been a precursor for this kind of sensitivity. Certainly, my veterans who are older experienced this as 'something that doesn't happen'" and are told to keep it quiet or are moved away to another unit or even punished."
She said this kind of shifting drastically disrupted and ruined the military careers of some veterans. "Once you've been targeted, I think the feeling is that you lose control of how people behave toward you," Dr. Pivar said.
Many of these veterans experienced MST in the Vietnam or post-Vietnam War era and have kept their trauma a secret for 30 or more years.
The types of sexual trauma include unexpected sexual overtures that are disruptive to self-identity, assault during or after combat (such as an assault by a medic), assault while in military prison, and being targeted by a person higher in command or being assaulted for being weak or small.
Possible clues to identifying MST in men include substance abuse (often severe), problems with sexual intimacy, difficulties with male relationships, marital relationship problems, problems with authority, fear of being labeled homosexual or sexually impotent, history of child sexual abuse or exposure to abuse, anger and aggression, and a history of violence.
The VA does have an effective screening program ("VA Data Reinforce Need for Treatment of Sexual Trauma," CLINICAL PSYCHIATRY NEWS, January 2008, p. 1), but Dr. Pivar suspects that some patients are missed because of stigma and shame. When patients are suspected of having MST, the best approach is to ask directly and empathically," Dr. Pivar said. After veterans begin to learn about their problem, they are "extremely amazed that other men have had this experience and also extremely surprised to know that the numbers of male and female MST survivors are about the same."
Dr. Pivar's presented a small pilot study of 10 male veterans from all military service branches who had experienced MST at a mean age of 20 years. Men were the perpetrators, except for one veteran who had been assaulted by two women. All patients were heterosexual; one man was bisexual.
When the men received treatment at a mean age of nearly 53 years, seven had had some combat exposure, six had been exposed to life-threatening disasters or accidents, four had experienced childhood loss of parental figures, six had observed domestic violence as a child, eight had experienced serious physical or verbal abuse as children, eight had sexual experiences as children with someone who was at least 5 years older, five had experienced a life-threatening illness since their MST, six have tried to commit suicide or self-harm as teenagers or adults, and all had severe substance abuse problems following their MST. …