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Combat: Unique Issue. Stressor-related Factors. Unique characteristics of a traumatic event that play a role in shaping post-traumatic functioning These factors may overlap with other traumatic events. Combat-Related Stressors. Type of combat plays an important role in shaping the response

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stressor related factors
Stressor-related Factors
  • Unique characteristics of a traumatic event that play a role in shaping post-traumatic functioning
  • These factors may overlap with other traumatic events
combat related stressors
Combat-Related Stressors
  • Type of combat plays an important role in shaping the response
  • Afghanistan and Iraq are the most sustained combat operations since Vietnam
  • Increased frequency and intensity of combat exposure
combat related factors contd
Combat-Related Factors contd.
  • Persistent danger of guerilla warfare and terrorist activities
  • Difficulty determining ‘who is the enemy’
  • Prolonged periods of vigilance
  • Rules of engagement that prohibit engaging in spite of the fact that the situation is threatening
  • Ongoing stress and strain
combat related factors contd5
Combat-Related Factors contd.
  • High casualty rates (now exceed 4000)
  • High ratio of wounded to killed so many are exposed to wounded comrades and to seeing their comrades killed
  • See high rates of civilian casualties including those of women and children
  • Moral conflict of killing others, including unintended death of civilians
meaning of war
Meaning of War
  • As the war continues, public support for the war wanes and can affect the perceived support of the service members;
  • No available research on this topic
what is military sexual assault msa
What is Military Sexual Assault (MSA)?
  • Sexual assault that occurs in the military setting
  • Victims and perpetrators can be male or female
how is msa different from other types of sexual assault
How is MSA Different from Other Types of Sexual Assault?
  • Military sexual assault occurs in a setting where the victim lives and works, and as a consequence:
    • Victim may rely on perpetrator for basic needs
    • Career goals may be disrupted
    • Victim may experience increased feelings of powerlessness
  • Anecdotal evidence suggests MSA may be underreported because of fear that:
    • Report will be ignored
    • Survivor will be blamed for the assault
    • There will be negative implications for career
prevalence of msa
Prevalence of MSA

In 1995, the Department of Defense conducted a study of active duty military members.

  • Findings from this study indicated that in the previous year, MSA had affected:
    • 6% of women
    • 1% of men

Consequences of MSA

In a study of female VA healthcare users

conducted in 1997:

  • 23% reported MSA at some time during
  • their military service
  • MSA was related to a number of health
  • outcomes, among them:
    • Mental health problems, including PTSD, depression, and anxiety
    • Gastrointestinal and pulmonary problems
    • Chronic fatigue, vision, and hearing problems
    • Dissatisfaction with sex life

(Skinner et al., 2000)

sexual assault and ptsd among returning iraq and afghanistan war veterans
Sexual Assault and PTSD amongReturning Iraq and Afghanistan War Veterans
  • Reports of sexual harassment and assault perpetrated by fellow military personnel, military leaders, allies, and foreigners have surfaced in the media

(Loeb, 2004; Martineau & Wiegand, 2005; “Sexual assaults,” 2005; Siemaszko, 2005)

Military members may be coping with additional deployment stressors, in addition to MSA, that increase the risk for negative health consequences

    • Lack of social support (Vogt, Pless, King, & King, 2005)
    • Family stress (Blount, Curry, & Lubin, 1992)
    • Combat and other war-zone stressors (Ritchie, 2001)
screening for military sexual trauma
Screening for Military Sexual Trauma
  • Military sexual trauma refers to both sexual harassment and assault experienced during military service
  • VA mandates universal screening for military sexual trauma
  • Important elements of the screening process include:
    • Establishing a comfortable climate for disclosure
    • Deciding on how screening will be conducted (e.g., as part of social history or on an intake form)
    • Introducing the line of questioning in a non-judgmental manner
    • Asking behaviorally-based questions (e.g., Did someone ever use force or the threat of force to have sexual contact with you against your will? [sexual assault])
screening for military sexual trauma in the va cont
Screening for Military Sexual Trauma in the VA (cont.)
  • Response to disclosure of military sexual trauma should include:
    • Validation/empathy
    • Education about post-trauma reactions
    • Assessment of current health and safety status
    • Assessment of support available to individual
  • All patients with a sexual trauma history should be offered the option of a mental health referral
screening for military sexual trauma in the va cont14
Screening for Military Sexual Trauma in the VA (cont.)
  • When making referral, it is important that the clinician know:
    • How to present the referral in a way that will maximize its acceptability to patient
      • Normalize experience
      • Offer options
    • Where to send the consult
      • Local VA’s Military Sexual Trauma Coordinator
      • Women Veterans Program Manager
      • Mental Health

(For more information, please see the Military Sexual Trauma Quick Reference Guide available through

the Employee Education System)