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Military Sexual Trauma MST

Military Sexual Trauma MST. Wounds of War Conference Diane T. Castillo, Ph.D. Coordinator, WSDTT February 6, 2008. Overview. Definitions Diagnoses and Statistics Effective Treatments. MST Mandate in VA System. Public Law 102-585 – Mandated outreach and counseling

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Military Sexual Trauma MST

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  1. Military Sexual TraumaMST Wounds of War Conference Diane T. Castillo, Ph.D. Coordinator, WSDTT February 6, 2008

  2. Overview • Definitions • Diagnoses and Statistics • Effective Treatments

  3. MST Mandate in VA System • 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

  4. Definitions by VA • “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?”

  5. Standard Definitions • 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

  6. Common Signs of Sexual Abuse • Depression • Anxiety • Sleep Difficulties • Alcohol/SA • Somatic Complaints

  7. Most Common Diagnosis: Post traumatic Stress Disorder--PTSD • Trauma • 3 Categories of Symptoms • Reexperiencing • Avoidance/Numbing • Hyperarousal • Symptoms last more than 1 month

  8. Trauma • 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.

  9. PTSD Symptom Categories • Reexperiencing (min. of 1) • Intrusive recollections • Nightmares • Flashbacks • Psychological distress with reminders • Physiological reaction to reminders • Avoidance/Numbing (min. of 3) • Avoidance of thoughts, feelings • Avoidance of reminders • Social isolation • Feelings of detachment from others • Reduction of emotions (positive) • Sense of foreshortened future

  10. PTSD Symptom Categories (cont.) • Hyperarousal (min. of 2) • Sleep difficulties • Irritability and/or anger outbursts • Poor concentration • Exaggerated startle response • Hypervigilence

  11. Demographics (N=236) 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

  12. Demographics (cont.) 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

  13. Percentages of MST in VA System

  14. Treatment for PTSD at Alb. VA • Trauma clinic for men—not just for combat-related 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

  15. Women’s Stress Disorder Treatment Team (WSDTT) Staff: • Two f/t psychologists • One f/t social worker • One h/t psychiatrist • One h/t nurse clinical specialist

  16. WSDTT Program Components • Assessment • Initial Interview • Psychological Testing (MMPI, MCMI, BDI, BUSS) • CAPS—Clinician Administered PTSD Scale

  17. Treatments: Groups, Individual, Medication • Core Groups: • PsychEd (intro) • Cognitive Processing** • Skills • Sexual Intimacy • Focus (exposure therapy)** **Most effective for PTSD

  18. Assessment Data 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

  19. Outcome Data with PCL 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

  20. Conclusion 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

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