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The Trauma Trifecta of Military Sexual Trauma: A Case Study Illustrating the Integration of Mind and Body in Clinical Work with Survivors of MST

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Abstract

Military sexual trauma (MST) has recently received much attention from the media in contemporary society. With the ever-increasing population of United States service members returning from the Iraq and Afghanistan wars, it is vital for any mental health practitioner to be aware of the epidemic that is sexual assault in the military, the unique trauma experiences of the MST survivor, and treatment implications incorporating multiple psychological theories. This article explores three factors, referred to as the trauma trifecta, in which the effects of MST are exacerbated: the loss of professional and personal identity, the regulatory functions of self harm behaviors, and the retraumatization that many service members endure as a result of the distinctive characteristics of the military culture and its service to veterans. A case study with clinical interventions will be utilized to demonstrate this concept of “the trauma trifecta” and the unique challenges in treating the PTSD symptoms that can result from MST in clinical therapy. Drawing from multiple theories in clinical treatment, this paper illustrates the strengths and limitations of cognitive-behavioral techniques, highlights the integration of feminist theory to illustrate the obstacles of power structures, and mind–body interventions, bridging the gap between talk therapy and body therapy. Through this unique integration of multiple therapies, the case study illustrates the veteran’s reengagement with her body and the reformulation of her identity post MST.

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References

  • Ader, M., Cuthbert, R., Hoechst, K., Simon, E. H., Strassburger, Z., & Wishnie, M. (2012). Casting troops aside: The United States military’s illegal personality disorder discharge problem. Veterans Legal Services Clinic, Jerome N. Frank Legal Services Organization at Yale Law School. http://www.vva.org/PPD-Documents/WhitePaper.pdf.

  • Adkins, M. (2013). A film that’s actually changing the world: (Director) Kirby Dick on the invisible war. The Life of the Law. http://lifeofthelaw.org/a-film-thats-actually-changing-the-world-kirby-dick-on-the-invisiblewar.

  • Allen, S. (2006, June 6). Woman files suit in forced strip search: Her rights were violated at medical center, she says. Boston Globe. Retrieved June 8, 2006 from http://www.boston.com/news/local/articles/2006/06/06/woman_files_suit_in_forced_in_strip_search/?p1=.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Google Scholar 

  • Arnow, B., Kenardy, J., & Agras, W. S. (1995). The emotional eating scale: The development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders, 18(1), 79–90.

    Article  PubMed  Google Scholar 

  • Beck, J. S. (2011). Cognitive therapy: Basics and beyond (2nd ed.). New York, NY: The Guilford Press.

    Google Scholar 

  • Briggs, B. (2013). Male rape survivors tackle military assault in tough-guy culture. NBC News. http://usnews.nbcnews.com/_2013/05/16/18301723-male-rape-survivors-tackle-military-assault.

  • Brown, L. S. (1994). Subversive dialogues: Theory in feminist therapy. New York: Basic Books.

    Google Scholar 

  • Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Brown, L. S. (2009). Feminist therapy. Washington, DC: American Psychological Association.

    Google Scholar 

  • Brown, P. L. (2013). Trauma sets female veterans adrift back home. The New York Times. http://www.nytimes.com/2013/02/28/us/female-veterans-face-limbo-in-lives-on-the-street.html.

  • Burgoyne, S. (2013). Why haven’t the Marines shown stronger support for women? The New York Times. http://atwar.blogs.nytimes.com/author/shelly-burgoyne/.

  • Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371–394.

    Article  PubMed  Google Scholar 

  • Dao, J. (2013). In debate over military sexual assault, men are overlooked victims. New York Times. www.nytimes.com/2013/06/24/us/in-debate-over-military-sexual-assault-men-are-overlooked-victims.

  • David, W. S., Simpson, T. L., & Cotton, A. J. (2006). Taking charge: A pilot curriculum of self-defense and personal safety training for females veterans with PTSD because of military sexual trauma. Journal of Interpersonal Violence, 21(4), 555–565.

    Article  PubMed  Google Scholar 

  • Davis, K. L., Panksepp, J., & Normansell, L. (2003). The affective neuroscience personality scales: Normative data and implications. Neuro-Psychoanalysis, 5, 57–69.

    Article  Google Scholar 

  • de Zwaan, M., Mitchell, J., Seim, H., Specker, S., Pyle, R., Raymond, N., et al. (1994). Eating related and general psychopathology in obese females with binge eating disorder. International Journal of Eating Disorders, 15, 43–52.

    Article  PubMed  Google Scholar 

  • Erikson, E. H. (1956). The problem of ego identity. Journal of American Psychoanalytic Association, 4, 56–121.

    Article  Google Scholar 

  • Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. London: Brunner-Routledge.

    Google Scholar 

  • Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse & Neglect, 14(1), 19–28.

    Google Scholar 

  • Finkelhor, D., Ormrod, R. K., Turner, H. A., & Hamby, S. L. (2005). Measuring polyvictimization using the juvenile victimization questionnaire. Child Abuse & Neglect, 29(11), 1297–1312.

    Google Scholar 

  • Flashbacks and Dissociation. (2011). Discussion started by AzureMind. https://www.ptsdforum.org/c/threads/identity-loss.17511/.

  • Flowers, C. M. (2013). Assault in the military or assault on the military. The Miami Herald. www.miamihearald.com/2013/6/17/3456455/assault-in-the-military-or-assault.html.

  • Freud, S. (1922). Two artificial groups: The church and the army. In Group psychology and the analysis of the ego (Standard Edition) (James Strachey, Trans.). New York: Boni and Liveright.

  • Gerlock, A. A. (2013). The challenging trifecta: Substance abuse, mental illness, and trauma. Presentation at “Treatment Courts: Celebrating Partnership” New York Association of Drug Treatment Court Professionals (NYADTCP), March 7, 2013. Retrieved June 1, 2014 from http://www.nyadtcp.org/userfiles/file/presentation/The%20challenging%20Trifecta%20handouts%20(Gerlock).pdf.

  • Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253–263.

    Article  Google Scholar 

  • Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192–205.

    Article  Google Scholar 

  • Greenspan, G. S., & Samuel, S. E. (1989). Self-cutting after rape. The American Journal of Psychiatry, 146, 789–790.

    PubMed  Google Scholar 

  • Hardoff, D., & Halevy, A. (2006). Health perspectives regarding adolescents in military service. Adolescent Health Services, 18, 371–375.

    Google Scholar 

  • Henderson, N. J., & Huon, G. F. (2002). Negative affect and binge eating in overweight women. British Journal of Health Psychology, 7(1), 77.

    Article  PubMed  Google Scholar 

  • Herman, J. (1992). Trauma and recovery. New York, NY: Basic Books.

    Google Scholar 

  • Herman, J. (1997). Trauma and recovery—The aftermath of violence: From domestic abuse to political terror (Reprint from original 1992 ed.). New York: Basic Books.

  • Huckshorn, K. A. (2006). Re-designing state mental health policy to prevent the use of seclusion and restraint. Administration and Policy in Mental Health and Mental Health Services Research, 33(4), 482–491.

    Article  PubMed  Google Scholar 

  • Hughes, D. A., & Baylin, J. (2012). Brain-based parenting: The neuroscience of caregiving for healthy attachment. New York, NY: W.W. Norton & Company.

    Google Scholar 

  • Hyun, J. K., Pavao, J., & Kimerling, R. (2009). Military sexual trauma. PTSD Research Quarterly, 20(2), 1–7.

    Google Scholar 

  • Jacobson, I. G., Smith, T. C., Smith, B., Keel, P. K., Amoroso, P. J., Wells, T. S., et al. (2009). Disordered eating and weight changes after deployment: Longitudinal assessment of a large US military cohort. American Journal of Epidemiology, 169(4), 415–427.

    Article  PubMed  Google Scholar 

  • Jennings, A. (1994, Fall). Retraumatizing the victim. Jounal of Mental Health Administration. Retrieved March 23, 2006 from http://www.sidran.org/anna.html.

  • Kammerer, R. & Mazelis, R. (2006). After the crisis initiative: Healing from trauma after disasters. Resource paper: Trauma and retraumatization. Presented at the “After the Crisis: Healing from Trauma after Disasters” Expert Panel Meeting, April 24–25, Bethesda, MD.

  • Kimerling, R., Gima, K., Smith, M. W., Street, A., & Frayne, S. (2006). The Veterans Health Administration and military sexual trauma. American Journal of Public Health, 97(12). http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2006.092999.

  • Kimerling, R., Street, A., Gima, K., & Smith, M. W. (2008). Evaluating of universal screening for military-related sexual trauma. Psychiatric Services, 59(6). http://jounrals.psychiatryonline.org/article.aspx?articleid=99453.

  • Kimerling, R., Street, A., Pavao, M., Smith, M. W., Cronkite, R. C., Holmes, T. H., et al. (2010). Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. American Journal of Public Health, 100(8), 1409–1412.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lisbon, B. & Aalto, G. (2008). Shape up: Corps tightens weight, appearance standards. Desert Warrior, 7(33). http://www.mcasyuma.marines.mil/News/DesertWarriorArchive.aspx.

  • London, A. S., & Wilmoth, J. M. (2006). Military service and (dis)continuity in the life course. Research on Aging, 28(1), 135–159.

    Article  Google Scholar 

  • Mattocks, K. M., Haskell, S. G., Krebs, E. E., Justice, A. C., & Yano, E. M. (2012). Women at war: Understanding how women veterans cope with combat and military sexual trauma. Social Science and Medicine, 74, 537–545.

    Article  PubMed  Google Scholar 

  • Miller, R. (2005). Yoga nidra: A meditative practice for deep relaxation and healing. Boulder, CO: Sounds True Inc.

    Google Scholar 

  • Mipham, S. (2003). Tunring the mind into an ally. New York, NY: The Berkley Publishing Group.

    Google Scholar 

  • O’Brien, C., Gaher, R. M., Pope, C., & Smiley, P. (2008). Difficulty identifying feelings predicts the persistence of trauma symptoms in a sample of veterans who experienced military sexual trauma. Journal of Nervous and Mental Disease, 196(3), 253–255.

    Google Scholar 

  • Ozier, A. D., Kendrick, O. W., Knol, L. L., Leeper, J. D., Perko, M., & Burnham, J. (2007). The eating and appraisal due to emotions and stress (EADES) questionnaire: Development and validation. Journal of the American Dietetic Association, 107(4), 619–628.

    Article  PubMed  Google Scholar 

  • Panksepp, J. (1998). Affective neuroscience: The foundations of human and animal emotions. New York, NY: Oxford University Press.

    Google Scholar 

  • Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York, NY: W.W. Norton & Company Inc.

    Google Scholar 

  • Powell, S. (2013). Military reform is toned down. San Antonio Express News. www.mysanantonio.com/news/military/article/Senate-committee-retains-chain-ofcommand.html.

  • Rinpoche, Y. M. (2010). Joyful wisdom: Embracing change and finding freedom. Boston, MA: Shambhala Publications.

  • Risen, J. (2013). Attacked at 19 by an air force trainer, and speaking out. The New York Times. http://www.nytimes.com/2013/02/27/us/former-air-force-recruit-speaks-out-about-rape-by-her-seargeant.

  • Rothchild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York, NY: W.W. Norton & Company Inc.

    Google Scholar 

  • Sadler, A., Booth, B., Mengeling, M., & Doebbeling, B. (2004). Life span and retreated violence against women during military service: Effects on health status and outpatient utilization. Journal of Women’s Health, 13, 799–811.

    Article  PubMed  Google Scholar 

  • Schore, A. N. (2003). Affect regulation and the repair of the self. New York, NY: W.W. Norton & Company Inc.

    Google Scholar 

  • Schultz, J., Bell, K., Naugle, A., & Polusny, M. (2006). Child sexual abuse and adulthood sexual assault among military veteran and civilian women. Military Medicine, 171(8), 723–728.

    PubMed  Google Scholar 

  • Segal, Z. V., Williams, J. M., & Teasdale, J. D. (2012). Mindfulness-based cognitive therapy for depression (2nd ed.). New York, NY: The Guilford Press.

    Google Scholar 

  • Settersten, R. A. (2006). When nations call: How wartime military service matters for the life course and aging. Research on Aging, 28(1), 12–36.

    Article  Google Scholar 

  • Siegel, D. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York, NY: The Guilford Press.

    Google Scholar 

  • Smith, S. B. (1995). Restraints: Retraumatization for rape victims? Journal of Psychsocial Nusing, 33(7), 23–28.

    Google Scholar 

  • Smith, B. N., Shipher, J. C., Schuster, J. L., Vogt, D. S., King, L. A., & King, D. W. (2011). Posttraumatic stress symptomatology as a mediator of the association between military sexual trauma and post-deployment physical health in women. Journal of Trauma and Dissociation, 12, 275–289.

    Article  PubMed  Google Scholar 

  • Steinhauer, J. (2013). Pentagon study finds sharp rise in military sexual assaults. The New York Times. www.nytimes.com/2013/05/08us/politics/pentagon-study-sees-sharp-rise-in-military-sexual-assaults.

  • Suris, A., & Lind, L. (2008). Military sexual trauma: A review of prevalence and associated health consequences in veterans. Trauma, Violence, and Abuse, 9(4), 250–269.

    Article  PubMed  Google Scholar 

  • Thomas, C. A. (2011). Healing trauma. In B. Boyce (Ed.), The mindfulness revolution (pp. 153–158). Boston, MA: Shambhala by Random House.

    Google Scholar 

  • Timmerman, G. M., & Acton, G. J. (2001). The relationship between basic need satisfaction and emotional eating. Issues in Mental Health Nursing, 22(7), 691–701.

    Article  PubMed  Google Scholar 

  • “Trifecta” [Def. 2]. (2013). In Merriam Webster Online. Retrieved January 11, 2014 from http://www.macmillandictionary.com/us/dictionary/american/trifecta/.

  • Turner, H. A., Finkelhor, D., & Ormrod, R. (2006). The effect of lifetime victimization on the mental of children and adolescents. Social Science & Medicine, 62, 13–27.

    Google Scholar 

  • Turner, R. J., & Lloyd, D. A. (1995). Lifetime traumas and mental health: The significance of cumulative adversity. Journal of Health and Social Behavior, 36(4), 360–376.

    Google Scholar 

  • United States Army Recruiting Command. (2013). Support army recruiting. http://www.usarec.army.mil/support/faqs.htm#age.

  • Valente, S. (2007). Military sexual trauma: Violence and sexual abuse. Military Medicine, 172(3), 250–265.

    Google Scholar 

  • Van der Hart, O., Nijenhyuis, E. R. S., & Steele, K. (2005). Dissociation: An insufficiently recognized major feature of complex PTSD. Journal of Traumatic Stress, 18(5), 413–423.

    Article  PubMed  Google Scholar 

  • Veterans Health Administration Office of Public Health and Environmental Hazards. (2004). Women veterans of operations Iraqi freedom and enduring freedom: Analysis of VA health care utilization—Report 1. http://dva.state.wi.us/News_Releases/OEF_first_roster_analysis.pdf.

  • Wallin, D. J. (2007). Attachment in psychotherapy. New York, NY: The Guilford Press.

    Google Scholar 

  • Williams, I., & Bernstein, K. (2011). Military sexual trauma among U.S. female veterans. Archives of Psychiatric Nursing, 25(2), 138–147.

    Article  PubMed  Google Scholar 

  • Woollaston, V. (2013). An adult at 18? Not any more: Adolescence now ends at 25 to prevent young people getting an inferiority complex. The Daily Mail. http://www.dailymail.co.uk/health/article-2430573/An-adult-18-Not-Adolescence-ends-25-prevent-young-people-getting-inferiority-complex.htm.

  • Worthington, E. L., & Langberg, D. (2012). Religious considerations and self-forgiveness in treating complex trauma and moral injury in present and former soldiers. Journal of Psychology and Theology, 40(4), 274–288.

    Google Scholar 

  • Yaeger, D., Himmelfarb, N., Cammock, A., & Mintz, J. (2006). DSM-IV diagnosed: Posttraumatic stress disorder in women veterans with and without military sexual trauma. Journal of General Internal Medicine, 21, S65–S69.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. School of Social Work, Loyola University of Chicago, 820 N. Michigan Ave., Chicago, IL, 60611, USA

    Terry B. Northcut

  2. The Orland Park Vet Center, U.S. Department of Veterans Affairs, 8651 W. 159th Street, Suite 1, Orland Park, IL, 60462, USA

    Amy Kienow

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Correspondence to Terry B. Northcut.

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Northcut, T.B., Kienow, A. The Trauma Trifecta of Military Sexual Trauma: A Case Study Illustrating the Integration of Mind and Body in Clinical Work with Survivors of MST. Clin Soc Work J 42, 247–259 (2014). https://doi.org/10.1007/s10615-014-0479-0

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