Transcript PTSD and MST

PTSD and MST
Sharon Robino-West
Peer Support Specialist/Advocate
Objectives
Participants Will Learn
• What is MST and how prevalent is it?
• Why we need to address PTSD caused by MST
• What are the effects of MST and how can we
respond and offer support?
Military Sexual Trauma
• Military Sexual Trauma (MST) is sexual assault
or repeated, threatening sexual harassment
that occurred during a Service Member’s
military service.
• Often includes behavior that is called
“grooming”, perpetrated by a known and
trusted person and often through the use of
coercion, such as the use of drugs or alcohol.
Some Statistics
National data from VA screening programs
reveal:
• 1 in 5 women and 1 in 100 men respond “yes”,
that they experienced MST when screened by
a VA provider.
• Although rates of MST are higher among
women, because there are so many more men
in the military, significant numbers of men
AND women seen in the VA have MST.
Prevalence
• Sexual assaults on females in the civilian
sector are reported at a 1 in 6 ratio
• Sexual assaults on females in the
military sector are reported at a 1 in 5
ratio
• An estimated 20% of OEF/OIF/OND
female veterans are reportedly victims
of MST
More on Prevalence
• The average age of MST victims is 18 - 29
• The Average age of perpetrators is 18 39
• Approximately 2/3 of sexual assaults are
committed by someone known to the
victim
Most Commonly Reported
Instance
The most common victim-perpetrator
relationship, reported by both female and
male victims, was military coworker (49% and
48%, respectively), and many perpetrators
were in the victim’s chain of command (23%
and 26%, respectively.)
Confidentiality
Service Members’ concerns about the
availability of mental health records to
the chain of command may be
particularly problematic for MST victims,
given that the perpetrator is within the
victim’s chain of command in about one
quarter of cases.
What’s the Connection?
Those who have endured sexual trauma in the
military are more prone to developing post
traumatic stress disorder than those who have
experienced sexual trauma outside of the
military. One reason is because a fellow
colleague or person respected by the victim is
often the perpetrator. The sexual abuse would
make further working difficult, especially if
victims must obey and respect the perp.
PTSD and MST
*While sexual assault is associated
with an increased risk of developing
a psychiatric condition, such as PTSD
and depression, being a sexual
assault victim does not necessarily
imply a psychiatric condition.
Relationship Between Trauma and
PTSD
In a recent study,
Forty three percent of (77) subjects with any
kind of trauma had PTSD. Sixty percent (48) of
subjects in the MST group and forty three
percent (76) of those in the Other Trauma
group had PTSD. The rate of PTSD was
therefore higher for women in the MST group
than the Other Trauma group.
Furthermore, among subjects
with PTSD, MST was most often
identified as the most distressing
trauma at the time of the
interview (twenty nine percent or
22 subjects).
Symptoms of PTSD
• Nightmares
• Little interest in enjoyable activities
• Negative physical reactions to stressful
situations
• Anger
• Hyper-vigilance
• Flashbacks
• Depression
Symptoms of PTSD Cont’d
• Poor concentration
• Avoidance of places and things that remind
the person of trauma
• Low sleep quality
• Anxiousness
• Hallucinations
Symptoms of MST
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Health complications
Anxiety
Poor relationships
Humiliation
Psychological damage and strain
Problems at work
Sexual dysfunction
Post Traumatic Stress Disorder
Effects of MST
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Depression
Avoidance
Eating Disorders
PTSD
Self Harm
Sleep Disturbances
Substance Abuse
Less than Honorable discharges
Homelessness
Suicide
A Particularly Troubling Effect of
MST
It has been said that victims of MST (who
report incidents) tend to receive a higher rate
of Personality Disorder diagnoses and
Adjustment Disorder diagnoses – denying
them the care and benefits that they need and
deserve.
Repercussions
• Underreporting is a significant problem due to
fear, stigma or shame – which complicates
victim care and holding offenders accountable
• Women in FY12 indicated on a survey that
they experienced unwanted sexual contact,
reported it, and 62% perceived some form of
social, administrative, and/or professional
retaliation or punishment
Screening
• The National Center for Posttraumatic Stress
Disorder suggests two screening questions for
MST:
• While you were in the military, did you
experience any unwanted sexual attention,
such as verbal remarks, touching, or pressure
for sexual favors?
• Did anyone ever use force or threats to have
sex with you against your will?
How Can We Respond?
• Learn how to properly screen for MST
• Familiarize yourself with the resources
and referrals available to the service
member
Restricted Reporting
• Restricted
– Confidential reporting, allowing a service member
to disclose to specified officials that he or she has
been the victim of a sexual assault.
– Victim receives access to medical care, counseling,
and advocacy without requiring officials to
automatically report to law enforcement or
initiate an official investigation.
Unrestricted Reporting
• Unrestricted
– Victim reports an incident of sexual assault, the
matter is referred for investigation and victim’s
rights are in effect
– Victims may receive health care, counseling and
advocacy services. Details of the incident are
reportable to command and law enforcement.
Encourage Resilience Factors
• Seeking out support from others, such as
friends and family
• Finding a support group
• Feeling good about one’s own actions in the
face of danger
• Having a coping strategy; getting through a
bad event and learning from it
• Being able to act and respond effectively
despite feelings of fear
Peer Support
• Peer support draws on social support
• Helps remove feelings of isolation
• Peer Support Specialists are trauma survivors
who can share their experience
• Peer support involves modeling resilient
behaviors and assisting in setting boundaries
• Peer support combined with one on one
counseling appears to be very effective in
supporting survivors
Self-Efficacy
• If a survivor is ready to do so, let them tell
their story.
• Personal testimony conveys the reality of
violence and trauma in a way that can’t be
denied. It provides hope to other women and
girls, demonstrating empowerment, voice,
self-determination and self-healing.
• It provides a role model of strength, resilience,
and healing to the world and other survivors.
Recommended Treatment
• When a veteran reports MST, validation and
empathy are the first line of treatment.
• Provide MST education, assess health status
and ask them about their support systems.
• Be aware that PTSD flare ups can occur during
medical encounters and clinical procedures.
• Assess for PTSD, major depression and
substance abuse.
Other Considerations
• Some women veterans do not identify
themselves as veterans
• Some women veterans do not know what
benefits they are eligible for
• Be aware that MST survivors are at risk for revictimization
• Offer to assist in locating services
US Department of Veterans Affairs
• VA offers a full continuum of mental health
services for Women Veterans
– Assessment
– Outpatient Treatment
– Inpatient and Residential Care
– Evidenced Based Treatment and Pharmacological
Interventions
Support
• Donna Higgins, MSW, LCSW, Women Veterans
Program Manager (402.995.4906 or
1.800.451.5796 ext.94906)
• Jody Griffin, VA Representative (402.232.7363)
• Lincoln Vet Center (402.476.9763)
• Omaha Vet Center (402.346.6735)
• Veterans Crisis Line (1.800.273.8255 press 1)
• Women Veterans Call Ctr (1.800.829.6636)
Resources
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Air Force, Navy and Guard SARCs
Offutt Family Support Center
Chaplains
SafeHelpline.Org (877.995.5247)
SA Support Groups (WCA Groups 402.345.6555)
MCC/WCA Women Veterans Support Group
(South Campus)
• Counselors in the At Ease Program
Women’s Center for Advancement
Sharon Robino-West
[email protected]
• 24/7 hotline: 402-345-7273
• Spanish hotline: 402-672-7118
• Office: 402-345-6555
• www.wcaomaha.org
• www.facebook.com/womenscenterforadvancement
• www.twitter.com/wcaomaha
Thank You
References
• Department of Veterans Affairs Services For
Military Sexual Trauma (MST), (Jan 29, 2014).
Bell, Margaret, PhD, Director of Education &
Training, National MST Support Team, VA
Mental Health Services
• DSM-IV Diagnosed Posttraumatic Stress
Disorder in Women Veterans With and
Without Military Sexual Trauma; Journal of
Gen Internal Medicine (March, 2006; Supp 3):
S65-S69. doi:10.1111/j.15251497.2006.00377.x
References Cont’d
• Military Sexual Trauma
http://www.ptsd.va.gov/public/pages/military
-sexual-trauma-general.asp
• Physical and Psychological Health Following
Military Sexual Assault: Recommendations for
Care, Research, and Policy. Santa Monica, CA:
Rand Corporation, 2013.
http://www.rand.org/pubs/occasional_papers
/OP382 Farris, Coreen, Terry L. Schell and Terri
Tanielian.
References Cont’d
• http://www.currentpsychiatry.com/articles/ev
idence-based-reviews/article/military-sexualtrauma-how-to-identify-a-unique-form-ofptsd
• http://www.sapr.mil/public/docs/directives/6
49502p.pdf DoDI 6495.02, March 28, 2013.