ptsd and rape trauma syndrome

As I search for info on the web I find stories about all types of syndromes related to Rape now MST is not only Rape but defined by the our Government as Military Sexual Trauma  

What is military sexual trauma (MST)?

In both civilian and military settings, service members can experience a range of unwanted sexual behaviors that they may find distressing. These experiences happen to both women and men. "Military sexual trauma" or MST is the term used by the Department of Veterans Affairs to refer to experiences of sexual assault or repeated, threatening acts of sexual harassment.
The definition of MST used by the VA is given by U.S. Code (1720D of Title 38). It is "psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty or active duty for training." Sexual harassment is further defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character."
In more concrete terms, MST includes any sexual activity where you are involved against your will. You may have been pressured into sexual activities. For example, you may have been threatened with negative consequences for refusing to go along. It may have been implied that you would get faster promotions or better treatment in exchange for sex. You may not have been able to consent to sexual activities, for example, if you were intoxicated. You may have been physically forced into sexual activities. Other MST experiences include:

• Unwanted sexual touching or grabbing.
• Threatening, offensive remarks about your body or your sexual activities.
• Threatening and unwelcome sexual advances.

If these experiences occurred while you were on active duty or active duty for training, they are considered to be MST.


MST PTSD FROM RAPE

PTSD

post-traumatic stress disorder is a normal emotional and psychological reaction to trauma (a painful, shocking experience such as rape, war or a natural disaster) that is outside of a person's normal life experiences.

Anyone who experiences a traumatic event can suffer from PTSD. PTSD can affect survivors of war, violent attacks, rape, car or plane accidents and natural disasters and can also affect people who witness these events.

Symptoms of PTSD include recurrent memories or flashbacks of the trauma, nightmares, insomnia and/or lack of interest in family, friends or hobbies. They may suffer from depression. They may also suffer from survivor guilt, have overwhelming emotions, and be irritable or jumpy.
rape trauma syndrome

Immediate reactions after a rape may vary. Some rape survivors remain controlled, numb, in shock, denial disbelief. They present a flat affect, quiet, reserved, and have difficulties expressing themselves. Other rape survivors respond quite differently - being very expressive and verbalizing feelings of sadness or anger. They may appear distraught or anxious and may even express rage or hostility against the medical staff attempting to care for them.

Various factors may aid or inhibit the survivors ability to resolve the issues associated by the rape. Positive feelings of self-esteem, good support systems, previous success in dealing with crisis and economic security all enhance her ability to heal. Survivors who can minimize, (deal with one small segment of the problem at a time ) often find success. Certainly survivors moved to action gain confidence as they implement decisions. But survivors who suffer with chronic stress, lack of support systems and prior victimization struggle less successfully to resolve their issues. Negative self-esteem often hinders their progress and paralyze their efforts. These victims often use maladaptive methods to deal with their stress. These factors hamper their ability to resolve the issues of the rape and move beyond it.

Rape victims can suffer a significant degree of physical and emotional trauma during the rape, immediately following the rape and over a considerable time period after the rape. A study of rape victims has identified a three-stage process, or syndrome, that occurs as a result of forcible rape or attempted forcible rape. This syndrome is an acute stress reaction to a life-threatening situation that can last from two years to a lifetime. It is also often known as rape trauma syndrome or rape related post traumatic stress disorder, rrpstd.

The acute phase begins immediately and lasts up to several days after the attack. The survivor feels violated and fearful and may be depressed�even suicidal. The victim struggles with feelings of loss of control and may note changes in appetite, sleep habits or social functions. Survivors may note change in their sexual patterns at this time.

The Acute Stage: This stage occurs immediately after the assault. It may last a few days to several weeks. During this stage the victim may:
seem agitated or hysterical or s/he may appear totally calm (a slogan that s/he could be in shock).
have crying spells and anxiety attacks.
have difficulty concentrating, making decisions, and dolling simple, everyday tasks.
show little emotion, act as though numb or stunned.
have poor recall of the rape or other memories.

In the second stage, it seems that survivors begin to resolve their issues. This stage is also called the "flight to health." But denial frequently masks the under lying problems as survivors make an effort to re-establish the routines of their life and bring back some semblance of control. Sometimes, in an effort to feel back in control, rape victims make dramatic changes in lifestyle or environment. They may quit a long-standing job or move to a new location to get a fresh start. They may dramatically change their appearance; cut their hair or perhaps change the colour. None of the changes brings about the security they search for as nightmares and phobias emerge. They work hard to suppress the feelings because dealing with them is so very painful.

The Outward Adjustment Stage: During this stage the victim resumes what appears to be from the outside her/his "normal" life. Inside, however, there is considerable turmoil which can manifest itself by any of the following behaviours:
continuing anxiety.
sense of helplessness.
persistent fear and/or depression.
severe mood swings (e.g. happy to angry, etc.).
vivid dreams, recurrent nightmares, insomnia.
physical ailments.
appetite disturbances (e.g. nausea, vomiting, compulsive eating).
efforts to deny the assault ever took place and/or to minimize its impact.
withdrawal from friends and/or relatives.
preoccupation with personal safety.
reluctance to leave the house and/or to go places which remind the victim of the rape.
hesitation about forming new relationships with men and/or distrustful or existing relationship.
sexual problems.
disruption of normal everyday routines (e.g. high absenteeism at work suddenly or, conversely, working longer than usual hours; dropping out of school; travelling different routes; going out only at certain times).


But the feelings do not go away as easily as before. Their re-surfacing introduces the third stage of the rape trauma syndrome. The client no longer denies the issues; she/he may want to talk about what happened. The client finds themselves more willing to accept counselling and get in touch with the feelings and emotions associated with the rape. Survivors may feel overwhelmed as they attempt to deal with feelings they struggled to suppress since the assault. Often some sensory stimulation triggers memories that call to mind the sexual assault. Suddenly the survivor seems to be re-living the trauma as the rape comes to life again. Nightmares, phobias, depression, reoccurring thoughts and sexual dysfunction monopolize her thoughts. She / he feels anxious to talk about it; to deal with it and is ready to seek therapy although she may not understand why the issues surface at that time. The stages are not linear and can vary as the victim works their way through. Survivors find themselves taking one step forward and two back as they vacillate between stages and labour to find their way.


The Resolution Stage: During this stage the rape is no longer the central focus in the victim's life. The victim begins to recognize that while s/he will never forget the assault, the pain and memories associated with it are lessening. S/he has accepted the rape as a part of her/his life experience and is choosing to move on from there. Some of the behaviours of the second stage may flare up at times but they do so less frequently and with less intensity. In this fashion the person who has survived has moved from being a " victim" to a "survivor".

While some survivors move forward and take control of their lives, other continue to suffer and may even develop post traumatic stress disorder ( rape trauma syndrome ) as result of the rape. They struggle with reoccurring thoughts about the trauma and find themselves in a state of hyper vigilance; easily startled and always anticipating another attack. Nightmares, flashbacks, and sleep disturbances disrupt their lives. Constant efforts to avoid the memories of trauma literally control their existence. Some rape survivors have post-traumatic stress disorder for years and need continuous counselling and support.

Recovery Takes Time

Survivors recover in stages. They may start with one stage, go to another, and go back. Each person processes the event his or her / his own way. Survivors are not to blame for the crime committed to them by another person. We cannot control the actions of another person. Survivors need a safe environment to work through their fears. You can help by providing the survivor with pace and time to recover.

The info about is from http://www.aest.org.uk/survivors/rts.html till we talk again remember what  
Winston Churchill said

"IF YOU'RE GOING THROUGH HELL, KEEP GOING"

Finding the right VSO and the right group to work with to get your VA benefits

So you have PTSD from MST who do you go to for help? Let me tell you my story and then you may understand.

As a survivor of MST this is

my story it is a non combat MST that happened to me when I was in The United States Army at Fort Jackson SC in May of 1980. I was a young 18 year old soldier who was in Basic Combat Training. I was hurt in a fall early in training and was not given medical care. I was upset and The Drill Sgts were calling me all types of derogatory names and making do things that were not the normal for a injuryed soldier.

One night I was told to do fire watch and then clean all the bathrooms and common areas of the dorms. I was going to get a new mop head in the duty office when I was jumped by 3 or 4 people who were all Drill Sgts and who tied me up gaged me and gang raped me for hours. I reported this the next day to my company commander who was a young Lt. acting as the company commanded this was his first command. He said that I was just making up stories to go home and that his men would never do anything like that to a soldier and his men were not fags or gay. I ask to go to the IG's office or to see a MP or Mental Health and was told why they would not believe me as I was just a Pvt. and He was a LT. and His men well respect Drill Sgts. Sometime during the next couple days I somehow made it to the Mental Health Clinic where I was told to go back to my company that I was not a good sldier and would not be allowed to stay in the Army. Not long after that I passed out and was put into the Hospital with a high temp and a infection in the lower part of my body. With in 10 days I was home and out of The US Army with a honorable discharge. But when I returned home my doctor said who did this to you and he sent me to the IG's office at Fort Monmouth and to the VSO for the state  after the visit to the VSO I was sent to the hospital at East Orange NJ were I was given treatment and sent home. My family doctor was a former Army doctor and treated me without cost and help me to get help from some of his friends at Fort Monmouth. The IG's office at Fort Monmouth sent my case to the IG's office at Fort Jackson but they never did anything due to no physical evidence for rape and the LT. was right the IG's office closed the case and sent a letter to the Fort Monmouth IG's saying that no physical or writen statement were found at Fort Jackson and that statements from all officers and drill sgts were the same all the soldier did the whole time was act out and complain that is why he was discharged and also due to his Borderline personality disorder. The LT. may have been a bad officer but he knew how to cover up for his men.

When I got my C-file 20 plus years later I started having flash back dreams about the Rape and I then became very depressed and called the Suicide Hotlines: Thats were I started my MST rediscover. So now I had to get help well it was not easy first the rape center I was sent to was for Women who were sexually assault and domestic violence and they said in their info that they worked with women, men and children after 3 visits I was told that the Director said the women did not like a man in the waiting room and I would have to find someone else. I think it was more about no insurance or money. I was talking to my VA  doctor and he said to go to the VA mental health clinic in Brick NJ and to talk to my VSO and file a claim when I went to my VSO who was my VSO for a very long time and was most of the time nice and helpful he did a 180 and started to be very nasty after I told him that I was raped in the service he did not want to file my claim and throw me out of his office I was shocked and hurt and felt like I was raped again. I called his boss and he was made to file my claim "Bet you can guess I was denied and right after they got a copy of the letter from the VA I was terminated from their service and they removed the POA for me from the VA" So here I was with no representative to help you present my appeal to the VA. So I looked for a new veterans service organizations I talk to every organization that I could find and was told it is very hard for a new VSO to file an appeal and they said I should do it myself the VA  rules and procedures are very complicated. It can be frustrating and hazardous to go it alone. Let me tell you it is and I lost because of the time stamp was over the limit by 1 week.
"GET HELP"
It is a good idea to get a representative to help you present your claim to the VA. VA rules and procedures are very complicated. It can be frustrating and hazardous to go it alone.
Many veterans service organizations and state and county veterans service agencies offer free assistance. No matter who you select to represent you, it is important that you be personally involved in your case and make certain that everything that should be done, is done.
Although it can be a difficult task, shop around for the best advocate. Talk to the prospective representative; ask if there are any limits on his service; get a feel for the person who will be working for you before you sign a power of attorney appointing the person as your representative. 
Go to our website www.mendmst.org and go to the help for MST survivors page and to the link page on these pages you will also find groups who can help you file who are made up of people who understand MST and the VA system. Friends you still need to know the laws and what you are a survivor entitled too. Here is a link to my friends blog check out the VA’s MST Policies and Treatment Benefits at http://jayherron.wordpress.com/2009/04/04/vas-policies-and-treatment-benefits/ 
Thanks Jay for all you do.

Sometimes VSO are not able to help you due to personal reasons like they have a hard core value system that says "Don't Tell Just Be A Man/Woman and live with it "Some Gave All All Gave Some" or they may have had something bad happen to them that they do not want to face. I pray for them every day its hard work and sometimes they get burned out and even have PTSD from it. Till next time remember what Winston Churchill said

"IF YOU'RE GOING THROUGH HELL, KEEP GOING"

I am a Compulive hoarder due to my PTSD MST

Hi friends its Tuesday night 1-18-2011 was just going to check for some paperwork for my case but I am a Compulive Hoarder and I would have just given up. So here I am at the computer blogging about why I am a Hoarding King. So I web search Hoarding and found this From Wikipedia, the free encyclopedia
Compulsive hoarding (or pathological hoarding or disposophobia)^[1] is the excessive acquisition of possessions (and failure to use or discard them), even if the items are worthless, hazardous, or unsanitary. Compulsive hoarding impairs mobility and interferes with basic activities, including cooking, cleaning, showering, and sleeping. A person who engages in compulsive hoarding is commonly said to be a "pack rat", in reference to that animal's characteristic hoarding.
It is not clear whether compulsive hoarding is an isolated disorder, or rather a symptom of another condition, such as obsessive-compulsive disorder.^[2

 ^{This my Apartment in Bradley Beach NJ where I think it is not sure whats under all of this stuff its been so long since it was all cleaned up like 4 years or so.} 

Characteristics

 

While there is no clear definition of compulsive hoarding in accepted diagnostic criteria (such as the current DSM), Frost and Hartl (1996) provide the following defining features:^[3]

• The acquisition of and failure to discard a large number of possessions that appear to be useless or of limited value
• Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed
• Significant distress or impairment in functioning caused by the hoarding
• Reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to kleptomania or stealing

According to Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego, compulsive hoarding in its worst forms can cause fires, unclean conditions (e.g. rat and roach infestations),^[4] injuries from tripping on clutter and other health and safety hazards.^[5] The hoarder may mistakenly believe that the hoarded items are very valuable, or the hoarder may know that the accumulated items are useless, or may attach a strong personal value to items which they recognize would have little or no value to others. A hoarder of the first kind may show off a cutlery set claiming it to be made of silver and mother-of-pearl, disregarding the fact that the packaging clearly states the cutlery is made of steel and plastic. A hoarder of the second type may have a refrigerator filled with uneaten food items months past their expiration dates, but in some cases would vehemently resist any attempts from relatives to dispose of the unusable food. In other cases the hoarder will recognize the need to clean the refrigerator, but due (in part) to feelings that doing so would be an exercise in futility, and overwhelmed by the similar condition of the rest of their living space, fails to do so.

 So after reading that I am a Hoarder I went to youtube and found this video she is talking about female but I feel it happens to male also.


I also found this

Trauma, PTSD and OCD

By Matthew Tull, PhD, About.com Guide

Updated May 25, 2010

PTSD and OCD or obsessive-compulsive disorder, as well as other anxiety disorders, often co-occur. PTSD has been found to commonly co-occur with other anxiety disorders, such as panic disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder.
In regard to obsessive-compulsive disorder (or OCD) specifically, studies have found that anywhere between 4% and 22% of people with PTSD also have a diagnosis of OCD. In addition, people with OCD also show a high likelihood of having experienced traumatic events. For example, one study found that 54% of people with a diagnosis of OCD report having experienced at least one traumatic event in their lifetime. The experience of traumatic events has also been connected to compulsive behaviors often seen in OCD, such as hoarding (for example, constantly acquiring and not getting rid of a large amount of possessions).

What Is OCD?

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, OCD is characterized by the experience of recurring excessive obsessive activities and mental rituals, as well as repetitive behaviors or thoughts (also called compulsions), such as hand washing, counting, or checking. Obsessions and compulsions can be defined as:

• Obsessions
  Obsessions are defined as recurring and persistent thoughts, impulses, and/or images that are viewed as intrusive and inappropriate. The experience of these thoughts, impulses, and/or images also cause considerable distress and anxiety.
  
  The obsessions in OCD are not just worries about real-life problems, and people will try (often unsuccessfully) to ignore or "push away" these recurrent thoughts, impulses or images. Finally, in OCD, people recognize that these obsessions are from their own mind (and not delusions like what might be seen in someone with a psychotic disorder).

Compulsions
Compulsions are defined as repetitive behaviors (for example, excessive hand washing, checking, hoarding, or constantly trying to put things around you in order) or mental rituals (for example, frequently praying, counting in your head, or repeating phrases constantly in your mind) that someone feels like they have to do in response to the experience of obsessive thoughts.Compulsions are focused on trying to reduce or eliminate anxiety or prevent the likelihood of some kind of dreaded event or situation.
To have a diagnosis of OCD, a person must experience obsessions and/or compulsions, view the obsessions and compulsions as being excessive and unreasonable, and experience considerable distress as a result of having these obsessions and compulsions.

How Are PTSD and OCD Connected?

In addition to PTSD, people who have experienced a traumatic life event may also be more likely to develop symptoms of OCD. In fact, it has been shown that the severity of a person's OCD symptoms is connected to the number of traumatic events they have experienced in their lifetime.
After experiencing a traumatic event, a person may constantly feel anxious and have concerns about their safety. Compulsive behaviors (like checking, ordering, or hoarding) may make a person feel more in control, safe, and reduce anxiety in the short-run. However, in the long-run, compulsive behaviors do not adequately address the source of the anxiety and can even increase the amount of anxiety someone experiences.

Getting Help for Your PTSD and OCD

If you have PTSD and OCD, it is very important to seek out treatment. There are a number of effective treatments available for PTSD and OCD. You can learn more about the treatment of OCD at the Obsessive Compulsive Foundation (or OCF). The OCF also provides information on how to find a therapist for your OCD and support groups in your area. Finally, Dr. Ashley Walters-Ingvoldstad, About.com Guide to OCD, provides a wealth of information on OCD, including its symptoms, how to cope with OCD, and its treatment.
<sub>Sources:

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author. Cromer, K.R., Schmidt, N.B., & Murphy, D.L. (2007). An investigation of traumatic life events and obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 1683-1691.
Cromer, K.R., Schmidt, N.B., & Murphy, D.L. (2007). Do traumatic events influence the clinical expression of compulsive hoarding? Behaviour Research and Therapy, 45, 2581-2592.
Hubbert, J.D., Moser, J.S., Gershuny, B.S., Riggs, D.S., Spokas, M., Filip, J. et al. (2005). The relationship between obsessive-compulsive and posttraumatic stress symptoms in clinical and non-clinical samples. Journal of Anxiety Disorders, 19, 127-136.
Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.


Well it time to say good night if I can find more info I will post it later till then remember</sub> "
Find the way out of Hell as Winston Churchill said

"IF YOU'RE GOING THROUGH HELL, KEEP GOING"

Happy Birthday Dr King "Your words moved many and we needed a man like you!".

Happy Birthday just does not fit for Today we as the nation celebrates 'Martin Luther King Day', in honor of an iconic figure in the development of civil rights in the US and around the world.. Yes Rev. Dr. King your words moved many and still today we fight for all to have civil rights. As I sit here in my small apartment looking over the memorial park in our small ocean side town covered in snow with christmas lights still aglow. I think who still does not have civil rights well it only takes one look at the flag pole to answer that it flying at half staff today" no not because it Martin Luther King Day its flying because some one is still fighting for our civil rights and dying everyday here is a small look at who and what they were doing. 23-year-old Army Pfc.
Benjamin Moore of Bordentown was killed by an improvised explosive device. A soldier from New Jersey killed in Afghanistan.so we could have civil rights.

Local Police Officer Killed  protecting our civil rights Officer Meatless was shot three times in his patrol car Friday, allegedly by suspect Jahmell W. Crockam, 19, of Lakewood. Matlosz died an hour after the shooting and Crockam was arrested in Camden on Sunday.
"He is the first officer I recall (shot to death) in my 38 years in law enforcement and that I remember 59 years as an Ocean County resident," said Deputy Chief Michael Mohel of the Ocean County Prosecutor's Office.
Matlosz, 27, had been a member of the Lakewood Police Department since 2006 and before that, had been an officer in Englishtown since 2004.
Mohel said an autopsy showed Matlosz died of three gunshot wounds to the head. The autopsy was performed Saturday at Community Memorial Hospital in Toms River by Dr. Ian Hood.

 It also makes me think of the American Homeless Veterans who is protecting their civil rights I think its not our Goverment and groups like American Homeless Veteran our doing there best but who is watching their civil rights.

And then Vets like me who is watching my civil rights the rights of the survivors of Military Sexual Trauma Thanks to people like Dr King Their is Veteran Advocacy Groups and great people who are Veteran Advocates. So as I close today I ask you not what can the words of Dr King do but what are you doing to protect our civil rights. HAPPY BIRTHDAY Rev. Dr. King.

Soldiers Raped by Other Men 24 08 2009 Men

Gentlemen with MST, we know you are there. We work with some of you, and we know the isolation and shame that you have been feeling for so long. We also know that now is the time to give up that shame and regain the peace and joy that is just on the other side of all the pain.
You are not alone. 4% of male soldiers experience MST¹, which equates to almost 1 in 20 of you. The VA says that more than 50% of the veterans who have screened positive for MST are men.² Thanks to your sheer numbers, more men have experienced MST than women (there are almost 22 million male veterans, compared to less than 2 million female veterans³). You are not alone.
Call us if you need someone to talk to who will listen with understanding and patience. If you want to talk privately and securely to other men with MST, please go here to request an invite to a confidential, all-male, online message board. They are waiting, because it is time to come home.
A male survivor who is also an MST advocate has this to say to you:
“The Silent Wounded. That is what I call us: the MST survivor . . . It is difficult to explain what it is like to enlist in the military service for our country – male or female – to be motivated to serve as an honorable duty. Our discharge papers may say under “honorable conditions,” but we feel no honor . . .
“The pain in one’s soul from being a rape survivor is no different from man to woman – the shame and guilt we feel are equally the same. Because of the way society places a stigma on male sexual assault that is compounded by the military comradeship and brotherhood instilled in us from our first day, we remain the “silent wounded.” Because of the way we were brought up to be men – the male image – these things are not supposed to happen. That is why we remain silent.
“The silence continues to victimize us . . . [but] once I found a voice through the use of the internet, I found myself with a freedom that had not been mine since the attacks on my body in 1969. I was able to speak out where once I felt I would never say a word. To understand the pain inside of you – the silence – it is like a poison and continues to eat at your soul . . . the written word of your voice gives you strength. I believe that is what the author of this web-site is offering you . . . the male survivor, to have a way to speak – to purge ourselves from the poison.
“Find that freedom. The more each of us speak up and say “that happened to me too!” the more our voice is heard further and further from the walls of our silence.
“We need to open up the eyes of everyone. The silence needs to change – awareness of how sexual trauma affects males needs to advance. We are hurting; we should quit doing it alone.”


¹Source: “Sexual Assault Among Male Veterans.” Psychiatric Times. 1 April 2005. <http://www.psychiatrictimes.com/display/article/10168/55225?pageNumber=3>
²Source: “Military Sexual Trauma.” National Center for PTSD. <http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/military_sexual_trauma_general.html?opm=1&rr=rr1758&srt=d&echorr=true>

³Source: “Veterans Numbers from the Census Bureau.” The Tacoma News Tribune. 16 October 2008. <http://blogs.thenewstribune.com/military/2008/10/16/veterans_numbers_from_the_census_bureau>

UCMJ Definitions of Military Harassment, Sexual Assault and Rape.

Men with military sexual trauma often resist disclosure

Clinical Psychiatry News, March, 2008 by Jeff Evans

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.
Only one patient had experienced a second sexual assault as an adult outside of MST.
Of the 10 patients, 7 have completed treatment in cognitive processing therapy (CPT) outpatient groups with 12-15 sessions (once per week) and significantly reduced PTSD symptoms (improved severity of depression, guilt cognitions, and self-esteem). Although the patients initially were resistant to joining a support group, after crossing that hurdle, they were motivated to continue treatment, she said.
The three dropouts faced medical problems, financial and housing problems, or they had the highest Clinician-Administered PTSD Scale (CAPS) symptom severity scores.
In conversations with veterans in the Cincinnati area about 3 years ago, Kathleen M. Chard, Ph.D., who directs the PTSD and anxiety disorders division at the Cincinnati Veterans Affairs Medical Center, said she continued to hear that the VA did not provide a suitable treatment setting for their problems.
These men said they had MST and would not feel comfortable in the center's 12-bed, 7-week residential treatment program for victims of all types of traumas, including MST and child sexual abuse. A separate resident program exists for females. A PTSD and anxiety disorders outpatient clinic also is located in the center.
"When you're sexually traumatized in the military by other veterans, combat veterans sometimes don't believe you and may in fact mock you," Dr. Chard said. Some residential trauma programs across the country also have been accused of saying things like:" 'We'll only take you through combat trauma, and if you have other types of trauma, we may allow you to talk about that privately--if there's time and therapist availability.'
"When I heard that, I immediately made a decision that we're going to change our modality," she said.
Now any veteran with PTSD from any event (such as child abuse, MST, or combat trauma) is welcome in the residential treatment programs.
Dr. Chard and her associates began offering CPT in 13 individual and/or group sessions. During group sessions, patients discussed their feelings associated with doing a homework assignment, sharing details of their life, participating in individual therapy, and sharing skills they've developed with others. In addition to CPT, the program added skills training in anger management, affect tolerance from dialectical behavioral therapy, relapse prevention, safety-seeking behaviors, mindfulness, relaxation, sleep, and medications. Patients who discussed the program in or outside of the groups faced immediate discharge.
This was a drastic culture change when it was possible to talk about trauma with anyone at any time. "I'm not saying that we're the best model, but we're the model that fit the needs of Cincinnati veterans at the time and with this response: Referrals have gone up about 25% since we created this change," she said at the meeting, which was also sponsored by Boston University.
In a sample of 30 male veterans with MST who were treated at the Cincinnati VA residential treatment program over a 1.5-year period, only 3 divulged their MST at the outset. None of the assessments that the clinicians ran (CPT, CAPS, Lang's information processing theory, Beck's cognitive-behavioral therapy) provided information to predict MST. Their MST had not been identified in any pretreatment notes at their home VA before coming to the Cincinnati VA. All met criteria for MST at some point in treatment. The veterans served in the Vietnam War (18), the post-Vietnam War era (9), and in the first Gulf War (3).
These 30 veterans "did very well" in treatment, Dr. Chard said, but even though they had similar pretreatment CAPS scores, they had less improvement in those scores after treatment than did non-MST veterans in the residential treatment program. The veterans with MST also entered treatment with poorer Beck's Depression Inventory scores than did non-MST veterans.
The veterans may be hindering their own treatment by not disclosing MST until trauma processing already has begun or even until after it has been completed. It seems to take 5-6 sessions for such veterans to build up enough trust with the therapist to mention their MST, Dr. Chard explained.
To avoid burnout, health care professionals at the center rotate between two residential and single outpatient clinics. Staffing averages at least half a psychiatrist, half a registered nurse, half a nurse practitioner, one psychologist, and one social worker per residential program, she estimated.
BY JEFF EVANS
Senior Writer

COPYRIGHT 2008 International Medical News Group

COPYRIGHT 2008 Gale, Cengage Learning