Transcript Assessing for Sexual Trauma

Wounds of War Conference
Diane T. Castillo, Ph.D.
Coordinator, WSDTT
February 6, 2008
► Definitions
► Diagnoses
► Effective
and Statistics
Treatments
► 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
► “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?”
► 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
► Depression
► Anxiety
► Sleep
Difficulties
► Alcohol/SA
► Somatic Complaints
► Trauma
►3
Categories of Symptoms
 Reexperiencing
 Avoidance/Numbing
 Hyperarousal
► Symptoms
last more than 1 month
► 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 person’s response involved intense fear,
helplessness, or horror.
► Reexperiencing
(min. of 1)





Intrusive recollections
Nightmares
Flashbacks
Psychological distress with reminders
Physiological reaction to reminders






Avoidance of thoughts, feelings
Avoidance of reminders
Social isolation
Feelings of detachment from others
Reduction of emotions (positive)
Sense of foreshortened future
► Avoidance/Numbing
(min. of 3)
► Hyperarousal





(min. of 2)
Sleep difficulties
Irritability and/or anger outbursts
Poor concentration
Exaggerated startle response
Hypervigilence
► Mean
Age=49.9, SD=10.4
► 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
► 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
Males
Females
Total
Yes—Reports
MST
2,718
(1.2%)
2,952
(23.2%)
5,670
(2.3%)
No—Does Not
Report MST
232,907
12,724
245,631
1,764
269
2,033
Screened—
Declined to
Answer
► Trauma
clinic for men—not just for combatrelated trauma
► Women’s Stress Disorder Treatment Team—
military/ childhood/other adult rape; other
traumas
► Both programs offer individual and group
counseling as well as medication
evaluation/management
Staff:
► Two f/t psychologists
► One f/t social worker
► One h/t psychiatrist
► One h/t nurse clinical specialist
► Assessment
 Initial Interview
 Psychological Testing (MMPI, MCMI, BDI,
BUSS)
 CAPS—Clinician Administered PTSD Scale
► Treatments:
► Core





Groups:
Groups, Individual, Medication
PsychEd (intro)
Cognitive Processing**
Skills
Sexual Intimacy
Focus (exposure therapy)**
**Most effective for PTSD
► CAPS:
 Current: M=73.8, SD=27.7
 Lifetime: M=104.9, SD=24.7
► 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 (BR>80).
► BDI: M=24.7, SD=11.9
► 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
► 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