Feature article

Working with Male Sexual Assault Victims in the Military

Examining what we know about sexual assault of men in the military and what research is still needed.

By Olivia S. Ashley, Jessica Kelley Morgan, Mark Relyea, Samantha Charm, Marian E. Lane, and Amy Street

Military sexual assault has gained increasing attention in recent years. The cases making the biggest headlines represent only a fraction of the actual problem. Sexual assault has severe consequences, including physical injury, medical illness (primarily pain-related symptoms involving multiple organ systems such as the gastrointestinal, neurological, genitourinary and musculoskeletal systems), and psychiatric pathology (post-traumatic stress disorder [PTSD], substance abuse and dependence, depression, anxiety, eating disorders and suicidal behavior; O'Brien & Sher, 2013; Tewksbury, 2007). Additional consequences of military sexual assault include damage to morale, trust and unit cohesion; mission degradation; and decreased readiness and retention (Stimson, 2013). According to a male sexual assault survivor in the Air Force, "It's sexual assault, and also it's mission degradation. It's putting a negative effect on the victim, for it creates mistrust within the unit, and it could also divide people."

The 2014 RAND Military Workplace Study found that 52 percent of servicemembers who experienced sexual assault in the past year were men (Morral et al., 2015). This article addresses Div. 19's Strategic Objective 2.0 to advance the practice of military psychology by presenting information from extant research and RTI International's document review and qualitative interviews with male sexual assault survivors and other male servicemembers.

As the Department of Defense (DoD) identified in its Plan to Prevent and Respond to Sexual Assault of Military Men (Department of Defense [DoD], 2016), information about male sexual assault victimization in the military is limited. Current sexual assault prevention and response (SAPR) training has been largely gender-neutral or has focused on female victims (U.S. Government Accountability Office, 2015). To effectively respond to sexual assaults on male servicemembers, clinicians need to better understand gender-specific contexts and needs.

Perpetrators

Approximately 70 percent of male servicemembers who were assaulted during the past year were attacked by men or a group of men and women (Morral et al., 2015). Although perpetrators of sexual assault against women are usually men, unrestricted reports made by male sexual assault victims in the military who wished to confidentially disclose the crime without triggering an official investigative process or notification to command have shown that perpetrators can be male or female peers, male or female superiors and same or opposite sex current or former dating partners (DoD, Sexual Assault Prevention and Response Office [SAPRO], 2016). Men were twice as likely as women to say that their sexual assault was meant to abuse or humiliate them (Morral et al., 2015). Male servicemembers who experience sexual assault are more likely than their female counterparts to have had multiple assailants in a given attack and to have been assaulted more than once (Morral et al., 2015).

Myths About Male Sexual Assault

A review of literature has shown that myths about male sexual assault may be stronger in the military than in civilian populations. In particular, the myth that men cannot be raped may be perpetuated because male sexual assault contradicts the military's reputation as an institution consisting of tough, masculine men (Turchik & Edwards, 2012). Some people believe that if a man did not physically resist or if he became erect or ejaculated during an assault, he consented or enjoyed it (Kassing, Beesley, & Frey, 2005; Turchik & Edwards, 2012). However, studies of male sexual physiology have suggested that these physiological reactions are only partially under voluntary control and can occur during times of extreme duress in the absence of sexual pleasure (Bullock & Beckson, 2011). Active duty male sexual assault survivors we interviewed said that strong "warriors" are perceived as not physically vulnerable; therefore, they cannot be raped or they should be able to fight off an attacker. In reality, many men and women experience tonic immobility during sexual assault, which involves immobility and muscle rigidity, intermittent eye closure, unfocused gaze, tremors, reduced vocalization and a sense of being cold (Coxell & King, 2010; see Figure 1). Male survivors also said that the derogatory terms about homosexuality used in the military promote the assumption that only gay men are perpetrators or victims. We also heard that others simply brushed off sexual assault under the guise of hazing, pranks or joking as "locker room" behavior and not assault, and many believe that men are not as affected by sexual assault as women (e.g., men "shouldn't be upset").

Risk Markers

Studies of male civilian, military and veteran populations have identified a few risk markers associated with sexual violence victimization. Incidence of sexual assault is higher among young men (younger than 19 years of age; Choudhary, Gunzler, Tu, & Bossarte, 2012). Gay, bisexual and transgender men are at higher risk of sexual assault victimization than are heterosexual men (Grant et al., 2011; Peterson, Voller, Polusny, & Murdoch, 2011; Rothman, Exner, & Baughman, 2011), although both gay and straight men can be victims or perpetrators. Research involving male veterans has found that child sexual abuse victimization was a significant correlate of sexual assault victimization in the military (Zinzow, Grubaugh, Frueh, & Magruder, 2008). Published analyses of data from the 2008 DoD Survey of Health-Related Behaviors Among Active Duty Military Personnel has identified PTSD as a correlate of sexual assault victimization among men (Hourani, Williams, Bray, & Kandel, 2014), and our analyses of these data also identified problematic alcohol use as a risk marker.

Contexts

Reviews of unrestricted reports and interviews with male sexual assault survivors and other male servicemembers identified several common contexts for sexual assault victimization. Excessive alcohol use by the perpetrator, victim or both was commonly identified. Other common contexts included falling asleep or passing out at a party, experiencing bullying or physical aggression and inappropriate sexual behavior by others (e.g., a roommate's intentionally masturbating in front of another person). Dangerous environments included dorms, hotel parties, deployment, all male work environments in selected job fields and unfamiliar environments, such as when on temporary duty or on a new assignment. Almost two thirds of male sexual assault victims in the 2014 RAND Military Workplace Study said their assaults occurred at work and during work hours (Morral et al., 2015).

Hazing

Many more men than women who are sexually assaulted in the military say their assault occurred during hazing (Morral et al., 2015). Interviews with male servicemembers identified contextual precursors to hazing involving sexual assault, such as peers using slang language (e.g., oil check, Gaddafi, credit card swipe), exhibiting a general air of aggression, whispering and laughing but going silent when the victim gets within earshot, suggesting that the victim not come to work or take a sick day tomorrow and using inappropriate or excessive touch or physical aggression (e.g., slapping buttocks in the workplace, pinching nipples, playing games where men get close to another man's face until he backs away).

First Responders

A sexual assault victim may disclose information to or seek help from several people, and anyone who may be a "first responder" must be prepared to address the unique aspects of male victimization. Victims may disclose or seek help from sexual assault response coordinators, mental health providers, SAPR victim advocates, legal staff, chaplains, commanders, security forces and/or the Office of Special Investigations (DoD, SAPRO, 2016). All of these staff members should be briefed on the context of male sexual assault victimization, myths and facts, language that is inclusive of unwanted male experiences (see Figure 2), the high risk of revictimization and information to help survivors stay safe in the future (how to identify red flags and prevention strategies).

Need for More Research

Male sexual assault victimization in the military is a highly sensitive but understudied issue. Knowledge about male sexual assault victimization in military and civilian populations is lacking because of the difficulty in accessing large numbers of male survivors who will self-identify and disclose. Much of the information regarding male sexual assault victimization in the military has come from journalistic sources and advocacy groups and has focused on victims and sequelae, not on perpetrators or prevention approaches. To develop effective preventive training and interventions, the context, distribution and characteristics of male sexual assault victimization within each service branch must be better understood. Formative research of this nature provides an opportunity to establish an empirical foundation to develop effective training on male sexual assault victimization and perpetration.

Qualitative data collection is needed to identify high-risk situations, realistic scenarios, red flags that signal risk of sexual assault, recommended strategies to implement when red flags are identified and appropriate language to use when working with male sexual assault victims, all of which may vary by service branch and/or pay grade. Quantitative survey data are needed to provide key information on prevalence, circumstances or characteristics and risk and protective factors associated with male sexual assault victimization and perpetration. In particular, research about revictimization and prevention has focused on female sexual assault victims, and further research is needed to inform services and programming focused on male sexual assault in the military.

Conclusion

Clinicians and others working with male victims of sexual violence in the military should consider this group's gender-specific contexts and needs, including information about perpetrators, myths and facts about male sexual assault, risk markers, contexts, hazing and first responders who can help these men. It is important to provide male sexual assault victims with access to a comprehensive range of psychological, medical and reporting options and referrals to services for ongoing support, including information to help them stay safe in the future and prevent revictimization.

Acknowledgment

This research was supported by funds from Cooperative Agreement 2014-39583-22643 from the U.S. Department of Agriculture.

For further information, please contact Marian E. Lane, RTI International

References

Bullock, C. M., & Beckson, M. (2011). Male victims of sexual assault: Phenomenology, psychology, physiology. Journal of the American Academy of Psychiatry and the Law Online, 39, 197-205.

Choudhary, E., Gunzler, D., Tu, X., & Bossarte, R. M. (2012). Epidemiological characteristics of male sexual assault in a criminological database. Journal of Interpersonal Violence, 27, 523-546.

Coxell, A. W. & King, M. B. (2010). Adult male rape and sexual assault: Prevalence, re-victimisation and the tonic immobility response. Sexual and Relationship Therapy, 25, 372-379. http://dx.doi.org/10.1080/ 14681991003747430

Department of Defense (DoD). (2016). Department of Defense plan to prevent and respond to sexual assault of military men. Retrieved from http://sapr.mil/ public/docs/prevention/DoD-Plan-to-Prevent-and- Respond-to-Sexual-Assault-of-Military-Men_Approved.pdf

Department of Defense (DoD), Sexual Assault Prevention and Response Office (SAPRO). (2016). Department of Defense annual report on sexual assault in the military: Fiscal year 2015. Retrieved from http://www.sapr.mil/public/docs/reports/ FY15_Annual/FY15_Annual_Report_on_Sexual_ Assault_in_the_Military.pdf

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.

Hourani, L. L., Williams, J., Bray, R. M., & Kandel, D. B. (2014). Posttraumatic stress disorder, substance abuse, and other behavioral health indicators among active duty military men and women. Journal of Traumatic Stress Disorders & Treatment, 3, 1-7.

Kassing, L. R., Beesley, D., & Frey, L. L. (2005). Gender role conflict, homophobia, age, and education as predictors of male rape myth acceptance. Journal of Mental Health Counseling, 27, 311-328. http:// dx.doi.org/10.17744/mehc.27.4.9wfm24f52kqgav37

Morral, A. R., Gore, K. L., Schell, T. L., Bicksler, B., Farris, C., Ghosh-Dastidar, M., ¼ Williams, K. M. (2015). Sexual assault and sexual harassment in the U.S. military: Vol. 2. Estimates for Department of Defense service members from the 2014 RAND Military Workplace Study (No. RR-870/2-1-OSD). Retrieved from http://www.rand.org/pubs/research_reports/ RR870z2-1.html

O'Brien, B. S., & Sher, L. (2013). Military sexual trauma as a determinant in the development of mental and physical illness in male and female veterans. International Journal of Adolescent Medicine and Health, 25, 269-274.

Peterson, Z. D., Voller, E. K., Polusny, M. A., & Murdoch, M. (2011). Prevalence and consequences of adult sexual assault of men: Review of empirical findings and state of the literature. Clinical Psychology Review, 31, 1-24.

Rothman, E. F., Exner, D., & Baughman, A. (2011). The prevalence of sexual assault against people who identify as gay, lesbian or bisexual in the United States: A systematic review. Trauma, Violence, & Abuse, 12, 55-66. http://dx.doi.org/10.1177/1524838010390707

Stimson, C. (2013). Sexual assault in the military: Understanding the problem and how to fix it (Special Report No. 149 on National Security and Defense). Retrieved from http://www.heritage.org/research/ reports/2013/11/sexual-assault-in-the-military- understanding-the-problem-and-how-to-fix-it

Tewksbury, R. (2007). Effects of sexual assaults on men: Physical, mental and sexual consequences. International Journal of Men's Health, 6, 22-35.

Turchik, J. A., & Edwards, K. M. (2012). Myths about male rape: A literature review. Psychology of Men & Masculinity, 13, 211-226. http://dx.doi.org/10.1037/a0023207

U.S. Government Accountability Office. (2015). Military personnel: Actions needed to address sexual assaults of male servicemembers (No. GAO-15-284). Washington, DC: Author.

Zinzow, H. M., Grubaugh, A. L., Frueh, B. C., & Magruder, K. M. (2008). Sexual assault, mental health, and service use among male and female veterans seen in Veterans Affairs primary care clinics: A multisite study. Psychiatry Research, 159, 226-236.