Understanding Military Sexual Trauma using Interpersonal Neuroscience Part I

20 Pages·2015·1.08 MB·English

Understanding 
Military Sexual Trauma 
using Interpersonal Neuroscience
Kristen Zaleski, PHD, LCSW
Clinical Assistant Professor
University of Southern California
School of Social Work
Part  I: 
Understanding PTSD using Judith Herman’s Trauma 
Theory and Interpersonal Neurobiology
Part II: 
Treating sexual trauma PTSD using Judith Herman’s 
Tri‐phasic Model and Modern Day Attachment Theory
Guilt
Rage
Shame
Rape
Secrecy
Betrayal
Isolation
© Duarte Design, Inc. 2009 1
Epidemic of Sexual Violence:
• “It was an astounding admission when Sen. John
McCain, R-Ariz., confessed that he had advised the
mother of a young woman interested in joining the
military that he couldn't in all good faith tell her it
was the right career path for her daughter. McCain
wasn't faulting the military for lack of opportunity, or
for gender discrimination, but for something far more
basic, the continued inability to protect service
women, and men too, from sexual assault, and to
give those who are the victims of assault or sexual
harassment a fair hearing without fear of retribution”
(Cohn, 2013).
Is Sexual Trauma in the Military a New
Phenomenon?
• Civil War rape on American women and slaves by Union and
Confederate officers (Murphy, 2014)
• 1991TailhookConference -US Navy and Marine Aviation Officers at the
Las Vegas Hilton
• 2004Donald Rumsfeld ordered investigation of the sexual abuse in OIF
and OEF
• 2014highest ranking officer to ever be accused of sexual misconduct in
the military, Jeffrey Sinclair, was accused of adultery, sodomizing, raping,
forcing oral sex, and harassing various young female enlisted soldiers
• 2014Air Force Academy implicated 32 cadets, including 16 football
players and several other athletes, after an investigative report found the
athletes administered date rape drugs rampantly, hosted wild parties,
and used illegal drugs, often with special permission of [coaches/school
officials] because of their athletic positions
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Sexual Harassment
55‐70% of military respondents reported 
sexual harassment during military 
service time in a meta analysis of 21 
studies 
(Goldzweig, Balekian, Rolon, Yano, & 
Shekelle, 2006).
““TThhee  bbaattttaalliioonn  ccoommmmaannddeerr  rreeqquueesstteedd  tthhaatt  II  ccoommee  aanndd  sseeee  hhiimm..  II  rreemmeemmbbeerr  
ggooiinngg  iinnttoo  hhiiss  ooffffiiccee..  HHee  wwaass  ssiittttiinngg  iinn  aa  hhuuggee  cchhaaiirr,,  ssmmookkiinngg  aa  cciiggaarr,,  aanndd  hhee  
ssaaiidd  ttoo  mmee  II  kknnooww  aabboouutt  yyoouu..  YYoouu’’rree  ttrroouubbllee..  YYoouu  ddoonn’’tt  wwaanntt  ttoo  bbee  ttrroouubbllee..  
MMoovviinngg  hheerree  yyoouu  hhaavvee  aa  rreeppuuttaattiioonn..  YYoouu’’rree  eeiitthheerr  aa  sslluutt  oorr  yyoouu’’rree  aa  ddyykkee..  
YYoouu’’vvee  ggoott  ttoo  cchhoooossee  yyoouurr  ffrriieennddss  wwiisseellyy..  II’’mm  wwaattcchhiinngg  yyoouu””  ((PP..  112200,,  HHiicckkss,,  
22001111))..
Military Sexual Trauma by the Numbers
• 2004 was 1,700 reports of sexual misconduct in
the military
• 2012 reports 3,374 (with 26,000 unreported
assaults during the same time period)
(Department of Defense, 2013)
• Recent wars in Iraq and Afghanistan found rates
of
– Women assaults 15-42 %
– Men assaults 1-12.5%
– Actual numbers are equal, percentages are different.
This is often misunderstood by the popular press
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Mental Illness due to MST
• PTSD was nine times higher for those who experienced
military sexual trauma (MST) than without sexual
trauma, and five times higher for those with MST than for
those with civilian trauma.
• Women are diagnosed with higher rates of PTSD than
men in many military studies.
• Male victims of MST experience PTSD as well as higher
rates of suicide and self harm (cutting) as well as sexual
health concerns such as higher rates of herpes,
HIV/AIDS, and syphilis
© Duarte Design, Inc. 2009 4
Today’s Discussion
• Provide theory to help you understand trauma
and it’s recovery
• Explain why PTSD is higher among MST
survivors than combat trauma
• Explain why MST can be more traumatizing than
a civilian sexual assault
• Use neurobiology to help you understand how to
help survivors now.
Overview of Herman’s Trauma Theory
Daniel Johnson, USC MSW student
• Defining the Characteristics of Trauma
– Terror
– Disconnection
– Captivity
• Considering Complex PTSD
– Need for a New Concept
– Survivors as Psychiatric Patients
• The Syndrome of Chronic Trauma
– A New Diagnosis
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Herman’s theory applied to military
training
• Leave personal identity/community/family and
given a new identity/Warrior Ethos (Disconnection)
• Separating feelings/emotions from actions
(disconnection)
• Hunger/Cold/Pain (disconnection & terror)
• Gas chamber (terror)
• Live fire exercises (terror & captivity)
• Military Contract (captivity)
• Taking orders (captivity)
Herman’s theory applied to combat
• Command (captivity & disconnection)
• Deployment (terror, disconnection, & captivity)
• Driving around (disconnection & terror)
• Humor, laughing in the face of danger
(disconnection)
• Engaging in combat (disconnection, terror, &
captivity)
• Seeing a dead body (terror & disconnection)
© Duarte Design, Inc. 2009 6
Neurobiology of PTSD
Stuck on “High” Hyperactivity
Traumatic Event
Hyper‐‐arousal Hypervigilance
or
Mania
Traumatic Triggers Anxiety & Panic
Rage
Pain
e
n
o
Z
t 
n
e
sili
e
R
Depression
Disconnection
Exhaustion/Fatigue Stuck on “Low”
Numbness Hypo‐arousal
Graphic adapted from an original graphic of Levine/Heller by Geneie Everett, PhD
14
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Herman's Language Neurobiology
Terror:When neither resistance nor escape Freeze Response. Dissociation. Extreme para-
is possible, the human system of self- sympathetic response to danger and threat.
defense becomes overwhelmed and
disorganized. Each component of the
ordinary response to danger, having lost its
utility, tends to persist in an altered and
exaggerated state long after the actual
danger is over (Herman, 1992, p.92).
Hyper-Arousal: A state of perpetual high
Elevation in the sympathetic nervous system
alert, high startle response, intense
arousal resulting in increased heart rate, blood
responses of anger and irritability that are
pressure, and oxygen levels while heightening
brought on with minimal provocation, and
senses, and increasing reaction times (Applegate &
deprived sleep (Herman, 1992).
Shapiro, 2005; Cozolino, 2010; Van DerKolk,
2014).
Intrusion: The reliving of events with the Limbic System Positive Feedback Loop: where
same vividness and emotional force as if intrusive memory or flashback produces a stress
they were happening in the present and are hormone that acts to strengthen the memory, thus
potentially caused by seemingly insignificant increasing the likelihood of its continuation (Cahill,
reminders (Herman, 1992). 1997).
Constriction: Withdrawal from others, PolyVagalTheory: disruption of the dorsal vagus
numbing of the self so as to separate from system or the brains unconscious method of social
intolerable pain, uncontrollable rage, or engagement (Porges, 2001).
intense terror, a narrowing of perception,
and an impoverished life (Herman, 1992).
All PTSD is not created equal
• PTSD from Combat and PTSD from rape are
very different diagnosis
– PTSD from combat characteristics
• Terror is experienced (you fight or flee in response)
• Person attacking you is “the enemy” (ie. Stranger).
– PTSD from rape characteristics
• Terror is experienced through a freeze response (as
protection)
• Person attacking you is “military family” (ie. Brother in arms).
• PTSD should be treated differently depending on
the client’s trauma experience
© Duarte Design, Inc. 2009 8
Risk Factors for Military
Sexual Trauma ( Suris & Lind, 2010)
• Military sexual trauma (MST) has been associated
with entering the military at a younger age, being of
enlisted rank, and being less likely to have
completed college.
• Almost 50% of women in one sample reported
escaping their home environment as reason for
entering the military.
• Those veterans with childhood sexual assault
histories have been found to be more likely to be
raped as an adult.
• Female soldiers have been found to have higher
rates of childhood sexual assault than their civilian
counterparts.
Combat PTSD & MST PTSD
Combat PTSD (men and • Military Sexual Trauma
women combined)
• Vietnam
• Vietnam
– 30.9%
– 29.3% women only
• Persian Gulf
• Persian Gulf
– 12.1%
– Men 49%, Women 50%
• OIF/OEF
• OIF/OEF
– 13.8%
– 60% women who report
MST
(National Center for PTSD) (Suris & Lind, 2010;
Yeager, et. al 2006)
© Duarte Design, Inc. 2009 9
Civilian rape vs.
Military sexual trauma
Civilian Sexual Assault  1 in 5 women (1 in 71  73% by a Non‐stranger 37.4% of female rape  Rape results in 32,000 
(CDC.gov) men) report rape in  victims assaulted  pregnancies each year
life span between age 18‐24
‐1 in 4 female  97% of victims of MST  About one half of the  Military women are 
Military Sexual Trauma  veterans (1 in 100  knew their assailants.  men and women in  withinchild bearing 
(MST) male) report MST to  the military are  age, therefore 
84% of attacks involve 
VA provider  between 17 and 24  pregnancy rates are 
a service member 
(Department of  years of age. 70% are  much higher for 
perpetrator. 
Veterans Affairs;  under age 30.  unintended pregnancy 
2014).  (Street & Stafford,  in general and rape 
(Department of 
2002; Farris, Schell &  specifically.
‐Estimates are 9.5%‐ Defense, 2007)
Tanielian, 2013) (No official 
33% of women report 
documentation of 
attempted or 
numbers is kept at this 
completed rape while 
time).
in the military 
(Turchick& Johnson, 
2010)
MST Compared to Civilian Rape
Victims of MST have:
• Have no access to medical care without permission
• Limited (if any) access to prophylaxis (pregnancy
prevention and STD prevention)
• Betrayal symptoms given the nature of the military
“family”
• No option to miss work (or quit their job)
• No option to move home
• No option to visit family/call friends as needed
• Limited psychological support (access to trained
professionals)
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