Defining military sexual trauma: establishing parameters and perspectives

ABSTRACT

Background: The term military sexual trauma [MST] is increasingly used to describe instances of sexual harassment/assault that occur between serving personnel during military service. However, in the absence of a clear universal definition, MST is an increasingly contested term, with confusion about its scope, application to differing jurisdictions and implications for responses and treatment.

Objective: This editorial provides a universal definition of MST, decoupled from any national system or framework.

Method: Drawing on existing international evidence about the nature and impact of MST.

Results and Conclusion: We argue that MST terminology provides a unique framing which recognises the institutional nature of MST victimisation and situates the context, behaviours, and impact on a continuum of violence.

HIGHLIGHTS

• MST terminology provides understanding and acknowledgement of the nuances of sexual harassment/assault in the military institution.

• MST terminology should encompass a continuum of sexual violence.

• Drawing on existing military health research, the authors contend that MST should be considered as a distinctive traumatic stressor.

1. Introduction

Military Sexual Trauma [MST] was a term introduced by the US Veteran’s Health Administration in 1999 as part of a universal healthcare screening programme (Kimerling et al., 2007), to describe ‘physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the former member of the Armed Forces was serving on duty, regardless of duty status or line of duty determination’ (38 U.S.C. §1720D). Broadly, therefore, MST describes instances of sexual harassment, and assault [SH/A herein], perpetrated by service personnel towards other service personnel. It remains a substantial challenge across the world’s militaries (Buyse et al., 2023; Moreau et al., 2021; Mota et al., 2023; NATO, 2024), with a recent US meta-analysis indicating that 15.7% veterans and serving personnel experienced SH/A during service, rising to 38.4% when considering just servicewomen (Wilson, 2018).

Since its inception, MST has become a widely adopted term across international academic research, campaign literature, and even political rhetoric in jurisdictions such as the USA and Canada.¹ Nevertheless, in the absence of a clear universal definition, MST has become an increasingly contested term, with confusion about its scope, application to differing jurisdictional contexts and its implications for responses and treatment. For example, whilst the US VHA definition has been widely used in research, it has been inconsistently applied and is crucially tied to US health/legal/veteran systems.

The following editorial, therefore, seeks to provide a universal exploration of MST terminology and its utility, decoupled from any national system or framework. In doing so, we argue that MST represents a unique continuum of violence that would benefit from an independent, and contextually bound definition that recognises the institutionalised nature of victimisation and enduring impact it often causes for victim-survivors. It is hoped that a common definition that acknowledges this unique continuum would assist in the development/assessment of tailored clinical interventions, act as a common starting point for comparative research, and would provide voice and recognition to those who feel their experiences of military SH/A have not been acknowledged by politicians, the military or indeed (some) practitioners.

The remainder of the paper thus delineates the complexities of MST, under the headings of ‘military,’ ‘sexual’ and ‘trauma,’ to frame military-specific experiences as distinct from (though overlapping with) comparative civilian experiences, whilst situating the potential context, behaviours, and impact of MST upon a continuum of violence.

1.1. Military

The military is a unique institution, both in terms of the circumstances within which service personnel work and live, and the independent systems (i.e. healthcare, education, and justice) situated within it (Herriott et al., 2023). These systems and the training that service personnel are subject to, are designed to maintain a strict hierarchy, and to mould those within it to meet the values and norms of military culture. In this way, the military has been considered a ‘total institution:’ one which controls and regulates the daily lives of those within, completely reshaping an individual’s identity and behaviour in line with institutional values and ideals, inhabiting physically and socially enclosed environments, having clear hierarchical structures and systems of authority, and involving a loss of autonomy (Goffman, 1961). We argue that it is this subculture, with its unique norms, roles, and social dynamics, that creates an environment permissive of SH/A and makes the experience unique compared to civilian contexts.

Indeed, the military is often described as a hyper-masculine environment, privileging characteristics such as strength and courage within a hegemonic masculine ideal (Eichler, 2017). Those who do not fit this ideal often face marginalisation, subordination, and undervaluation (Connell & Messerschmidt, 2005). Hypermasculine cultures are thereby regularly associated with an increased prevalence of SH/A (Trade Union Congress, 2016; Wadham & Connor, 2023), with increased rates seen in the military compared to the civilian context (Stander & Thomsen, 2016).

Furthermore, military values and norms include a strong focus on obedience to the chain of command, strong group cohesion, and protection of the military organisation over and above the needs of the individual (Herriott et al., 2023). This ingrained culture of silence and notion of ‘service before self’ has thus been reported to lead to protection of perpetrators of SH/A within the military and creates challenges for those wishing to make a complaint against others within their unit/chain of command, often fearing retaliation and a lack of accountability (Wilson, 2018).

Though the military is not the only organisation that might be considered hypermasculine or a total institution – for example the police and fire service may fall into this category, also reporting significant issues with misogyny, SH/A (Turner, 2024) – there are additional factors that indicate the military is on the more extreme end of what we might consider the continuum of total institutions. For example, factors such as living on base, relying on the military institution for basic needs such as accommodation and food, and having separate legal and medical structures that deal with victimisation experiences, together exemplify the often, all-encompassing institutional nature of military life.

1.2. Sexual

Given that military culture has been identified as an inherent risk factor for increased SH/A, researchers internationally have begun trying to understand if and how patterns of SH/A in the military context, differ from those observed in the civilian world.

Though it remains difficult to accurately estimate true prevalence rates, what is clear is the concerning normalcy with which SH/A occurs throughout military institutions internationally (Parliament New Zealand, 2023). Indeed, #MilitaryMeToo detailed widespread narratives of SA/H in service, troubling cultures of misogyny and casual endemic sexism within military services globally. It is therefore useful draw upon Kelly's (1987) ‘continuum of sexual violence’, which positions SH/A as part of a continuous series of events which often blur into one another, and which are underpinned by deeply interconnected norms and values. This normalisation of SH/A which have often been found to be an accepted part of military culture, justified on the basis of banter or building camaraderie (Defence Select Committee, 2021); must therefore be seen as problematic since they create a foundation for rarer forms of sexual misconduct including serious sexual assault and rape (Kelly, 1987).

Pertinently, US researchers have even suggested military socialisation processes, and constructions of so-called military masculinity can in fact serve to engender a tolerance towards SH/A amongst military communities (Wood & Toppelberg, 2017). Similarly, military sexual assaults are more likely to be overlooked as acts of ‘hazing,’ which is considered as a ‘rite of passage’ in the military community, rather than being acknowledged as an act of sexual violence (Bourke, 2016). Thus, despite several clear ‘zero tolerance’ policies towards all ‘unacceptable sexual behaviours’ internationally, the cultural context of offending in the military must be scrutinised to effectively tackle these behaviours.

Meanwhile the blurred social, professional, and living context has been shown to create additional challenges for victim-survivors, acting both as a deterrent to reporting and amplifying negative outcomes. For example, in Dardis et al.’s (2018) US-based research, 91% of surveyed female veterans disclosed barriers to reporting in the military and of those who did report, all disclosed some degree of negative reaction to the disclosure, including perceived cover-ups of abuse, lack of thorough investigations and the victim-survivor themselves being investigated. Other research has identified ostracism by colleagues, isolation from peers, loss of support and disruption to unit cohesion as further consequences feared and experienced by those reporting SH/A in the military context (Galovski et al., 2022).

Given these insights, both the experience of and response to SH/A in service, is inherently shaped by wider contextual factors of the military institution. Understanding and acknowledging these nuances through provision of unique terminology, therefore, helps us to contextualise and better respond to, these unique victim-survivor experiences.

1.3. Trauma

Finally, the potential negative health sequalae following MST are myriad, with the most significant outcome being PTSD (Hendrikx et al., 2023), which is typically higher among individuals who report sexual assault compared to sexual harassment (Kimerling et al., 2007). Other negative outcomes include depression and generalised anxiety disorder (Klingensmith et al., 2014), and suicide risk (Kimerling et al., 2016). Drawing on existing military health research therefore, the authors contend that MST should be considered as a distinctive traumatic stressor, in the same vein as combat exposure.

MST is more likely to result in PTSD which is also more likely to be comorbid (Maguen et al., 2012), and results in different health outcomes compared with other miliary-specific traumas like combat exposure. For example, Breland et al. (2018) found that MST was associated with a two-fold risk of eating disorders in women veterans, whilst combat exposure was not.

Meanwhile, veterans who experienced military sexual assault reported poorer mental and physical health and social satisfaction compared to both veterans and non-veterans who had experienced sexual assault outside the miliary, either as a child or adult (Holder et al., 2023). These findings suggest a specific deleterious impact of the military context.

If MST is to be considered a unique traumatic stressor, then guidance must be taken from the current diagnostic nosologies. Accordingly, military sexual assault undoubtedly fulfils the requirements of an index stressor necessary for a PTSD diagnosis under both DSM-5-TR and ICD-11 (American Psychiatric Association, 2013; World Health Organisation, 2019) However, at first glance military sexual harassment may not. Nonetheless, as has been described, harassment can exist on a continuum of linked interpersonal violence, and whilst the severity of symptoms may differ depending on the type of MST experienced, the outcomes themselves do not (e.g. Blais et al., 2019).

Beyond PTSD, MST demonstrates the necessary and sufficient characteristics to be considered a continuum of potentially morally injurious experiences that may represent a ‘high stakes’ institutional and personal betrayal of the veteran’s moral code (Bonson et al., 2023). Perceptions of institutional betrayal following MST are associated with more severe mental health outcomes (Andresen et al., 2019) and decreased willingness to engage with veteran support services (Monteith et al., 2021), further suggesting that the institutional military culture can compound negative outcomes for victim-survivors.

We therefore contend that when viewed in relation to clinical outcomes and other traumatic exposures, MST represents a unique stressor. Furthermore, it is a particularly insidious, chronic, and potentially cumulative set of experiences, particularly when situated in the military environment where lack of confidentiality and opportunity for reporting, fear of reprisals, and having to work and socialise with one’s aggressor(s) are commonplace (Campbell et al., 2023).

2. Summary of working definition

Given these insights into why and what makes MST worthy of consideration as a unique stressor, it is incumbent on the authors to offer an operationalizable definition of their own. Accordingly, it is our view that MST is:

• a continuum of violence encompassing acts of sexual harassment and assault,

• perpetrated by service personnel against other service personnel,

• that take place at and are directed at the individual level,

• which occur during military service and in a military context,

• and have the potential to result in adverse mental, physical, and social health outcomes.

In doing so, MST is defined as a unique form of trauma, acknowledging the nuances and complexities of SH/A perpetrated in the military context and with a specific pattern of health outcomes.

With increasing use of the term MST amongst veteran organisations, a universal definition promotes clarity and consistency for academics and professionals. We hope that it will guide training and increase awareness amongst professionals, offer insights on how to assess for MST including the types of questions to ask using behavioural measures and assist in data collection to gather more accurate prevalence figures. For researchers, we hope that adoption of a common international terminology we promote consistency in data collection. We therefore promote use of NATO’s recently developed, validated scale to assess SH/A in service (NATO, 2024), allowing us to better understand prevalence rates, risk factors and allowing better comparison between countries.

Nevertheless, we acknowledge the limitations and scope of MST, with Morgan (2022)rightfully cautioning that we cannot lose clarity around individual forms of offending by using overarching composite definitions. Whilst we argue the merit of a universal definition, careful consideration must be given to how to best collect data around SH/A in each instance. However, any definition in an applied research and clinical context potentially needs to sit outside legal definitions as they are not sacrosanct. Similarly, other official definitions are sensitive to political and social pressures. Thus, an evidence-led approach to a working definition is required.

We also acknowledge the potential similarities of SH/A occurring in other total institutions (such as first responder groups), for which we hope a definition of MST can provide a useful initial comparator. Indeed, our attempted definition is not designed to be canonical; rather it should be interpreted as a first step in a lingua franca for further cohesive interrogation of the issue. It is incumbent on the veteran health community how such a definition can be operationalised, whilst we modestly suggest that a central aim of informing the translational research agenda that can lead to positive, real-world improvement is constantly kept in mind.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

No data set associated with this paper.