Childhood abuse and premilitary sexual assault in male Navy recruits

Military Sexual Trauma: Gender, Military Cultures, and the Medicalization of Abuse in Contemporary America

Sexual violence is a serious problem within armed services. This article explores intra-service rape in branches of the U.S. military from the 1990s to the present. The article begins by establishing the parameters of the crisis of sexual abuse within the U.S. armed services. Second, it explores systematic failures to recognize forms of suffering. Victim-survivors in the military are vulnerable to military-specific obstacles to reporting their abuse and being believed. Attention is paid to differences by gender and sexual orientation. Third, it analyses the medicalization of suffering in the modern military and its effects. What meanings are assigned to 'military sexual trauma' (MST) and how has that label affected victim-survivors of rape or sexual assault? The article concludes by arguing that the concept of 'trauma' as it is applied to victims of sexual abuse does a formidable amount of political and ideological work.

Revisiting the link between childhood sexual abuse and adult sexual aggression

BACKGROUND

Childhood maltreatment poses a risk factor for adult sexual aggression among men.

OBJECTIVE

Efforts were made to examine links between childhood sexual abuse (CSA) and sexual aggression after controlling variance associated with other forms of abuse.

PARTICIPANTS AND SETTING

This sample was comprised of men (n = 489) who completed a national survey regarding their history of possible abuse and/or sexual aggression.

METHODS

Maltreatment indices included CSA, parental and sibling physical abuse, exposure to domestic violence, peer bullying, and family emotional abuse. Self-report indicators of sexual frotteurism, coercion and rape were provided by the Sexual Experiences Survey-Short Form Perpetration.

RESULTS

CSA links with the criterion indicators were relatively stronger (r = 0.36, d = 0.65, p <  .001) than those found for non-sexual forms of abuse. CSA accounted for unshared variance in sexual aggression with these effects magnified by the addition of parental physical abuse (d = 2.1) or exposure to domestic violence (d = 2.2). The relative risks of prior acts of rape were elevated by CSA (RR = 4.39, p <  .001), parental physical abuse (RR = 3.85, p < 0.001), exposure to domestic violence (RR = 3.81, p <  .001), or sibling physical abuse (RR = 2.56, p = 0.007). These risks of completed rape were higher as well among respondents polyvictimized by two (RR = 4.92, p <  .001) or more (RR = 8.94, p < 0.001) forms of abuse.

CONCLUSIONS

Multiple forms of child maltreatment, particularly CSA, were strongly associated with adult sexual aggression in this sample of men from the general population.

Child Sexual Abuse and Negative Affect as Shared Risk Factors for Sexual Aggression and Sexual HIV Risk Behavior in Heterosexual Men

Previous research has suggested that sexually aggressive behavior and sexual HIV risk behavior are associated. Childhood sexual abuse (CSA) is a well-established risk factor for both types of problematic sexual behavior. Negative affect (i.e., anxiety, depression, and anger) is a less well-studied risk factor, but it has been theorized to relate to both sexual aggression and HIV risk behavior. Thus, this study sought to (1) confirm the relationship between sexual aggression and HIV risk behavior, (2) establish CSA and negative affect as shared risk factors for sexual aggression and HIV risk behavior, and (3) evaluate whether negative affect mediates the relationship between CSA and sexual aggression and between CSA and HIV sexual risk in a sample of heterosexual men. We recruited 18- to 30-year-old heterosexual men (N = 377) from urban sexually transmitted infection clinics. Men completed measures of sexual HIV risk history (number of partners and condom use), sexual aggression history, CSA history, and trait negative affect (anger, anxiety, and depression). Structural equation modeling was used to examine hypothesized direct and indirect relationships. In the final SEM model, sexual aggression history and sexual HIV risk behavior were correlated. CSA was associated with both types of problematic sexual behavior. Anxiety significantly mediated the relationship between CSA and sexual aggression and between CSA and sexual HIV risk behavior (χ ²[1300] = 2121.79, p < .001; CFI = 0.905; RMSEA [90% CI] = .044 [.041-.047]). Sexual aggression appears to be part of a constellation of sexual risk behaviors; thus, it may be possible to develop prevention programs that target both sexual HIV risk and sexual aggression. CSA is a shared risk factor for sexual aggression and HIV risk behavior through the pathway of anxiety. Thus, anxiety might be one promising target for intervention.

Developing a Risk Model to Target High-risk Preventive Interventions for Sexual Assault Victimization among Female U.S. Army Soldiers

Sexual violence victimization is a significant problem among female U.S. military personnel. Preventive interventions for high-risk individuals might reduce prevalence, but would require accurate targeting. We attempted to develop a targeting model for female Regular U.S. Army soldiers based on theoretically-guided predictors abstracted from administrative data records. As administrative reports of sexual assault victimization are known to be incomplete, parallel machine learning models were developed to predict administratively-recorded (in the population) and self-reported (in a representative survey) victimization. Capture-recapture methods were used to combine predictions across models. Key predictors included low status, crime involvement, and treated mental disorders. Area under the Receiver Operating Characteristic curve was .83-.88. 33.7-63.2% of victimizations occurred among soldiers in the highest-risk ventile (5%). This high concentration of risk suggests that the models could be useful in targeting preventive interventions, although final determination would require careful weighing of intervention costs, effectiveness, and competing risks.

Review of survey and experimental research that examines the relationship between alcohol consumption and men's sexual aggression perpetration

This article systematically reviews empirical studies that examine associations between alcohol consumption and men's sexual aggression with the goal of identifying major findings; gaps in current knowledge; and directions for future research, practice, and policy. We identified 25 cross-sectional surveys, 6 prospective studies, and 12 alcohol administration experiments published between 1993 and August 2013 with male college students and young adult (nonincarcerated) samples. Many cross-sectional surveys have demonstrated that distal and proximal measures of men's alcohol consumption are positively associated with sexual assault perpetration, although very few of these studies evaluated how alcohol interacts with other risk and protective factors to exacerbate or inhibit sexual aggression. There are surprisingly few surveys that examine alcohol's effects at the event level and over short-time intervals to identify how changes in alcohol consumption are associated with changes in perpetration status. Alcohol administration studies suggest some important mechanisms that warrant additional investigation.

Self-reported sexual assault in convicted sex offenders and community men

Although self-reported sexual assault perpetrated by men against women has been well documented among college men, less is known about self-reported perpetration among convicted sex offenders and community men. This study provides unique descriptive and comparative information on sexual assaults in these understudied populations. Participants were 40 convicted sex offenders and 49 demographically comparable community men who completed the Sexual Experiences Survey (SES; Abbey, Parkhill, & Koss, 2005; Koss, Gidycz, & Wisniewski, 1987) and other surveys to capture the promiscuous sex and hostile masculinity pathways posited by the confluence model (Malamuth, 2003). We found notably few differences between sex offenders and community men in the rate and severity of sexual assault perpetration and the tactics used to obtain unwanted sexual contact. Specifically, 68% of sex offenders and 59% of community men acknowledged they had perpetrated sexual assault. Both groups used guilt and anger as the most frequent tactics to obtain unwanted sexual activity from their female victims. Consistent with the confluence model, an impersonal orientation toward sexual relationships was associated with sexual assault for both sex offenders and community men. Future directions for research on sexual assault perpetration and violence prevention efforts are discussed in light of these findings.

A systematic qualitative review of risk and protective factors for sexual violence perpetration

The current review summarized results of 191 published empirical studies that examined the risk and protective factors for sexual violence perpetration. Studies in the review examined factors for perpetration by and against adolescents and adults, by male and female perpetrators, and by those who offended against individuals of the same sex or opposite sex. Factors associated with child sexual abuse (CSA) perpetration were not included. In all, 2 societal and community factors, 23 relationship factors, and 42 individual-level factors were identified. Of these 67 factors, consistent significant support for their association with SV was found for 35, nonsignificant effects were found for 10, 7 factors had limited or sample-specific evidence that they were associated with SV but were in need of further study, and 15 demonstrated mixed results. The factors identified in the review underscore the need for comprehensive prevention programs that target multiple risk and protective factors as well as factors that occur across the social ecology. Moreover, we identified two domains of factors--the presence and acceptance of violence and unhealthy sexual behaviors, experiences, or attitudes--that had consistent significant associations with SV but are not typically addressed in prevention programs. Therefore, SV prevention may also benefit from learning from effective strategies in other areas of public health, namely sexual health and youth violence prevention.

Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study

OBJECTIVE

To describe the prevalence and patterns of rape perpetration in a randomly selected sample of men from the general adult population, to explore factors associated with rape and to describe how men explained their acts of rape.

DESIGN

Cross-sectional household study with a two- stage randomly selected sample of men.

METHODS

1737 South African men aged 18-49 completed a questionnaire administered using an Audio-enhanced Personal Digital Assistant. Multivariable logistic regression models were built to identify factors associated with rape perpetration.

RESULTS

In all 27.6% (466/1686) of men had raped a woman, whether an intimate partner, stranger or acquaintance, and whether perpetrated alone or with accomplices, and 4.7% had raped in the last 12 months. First rapes for 75% were perpetrated before age 20, and 53.9% (251) of those raping, did so on multiple occasions. The logistic regression model showed that having raped was associated with greater adversity in childhood, having been raped by a man and higher maternal education. It was associated with less equitable views on gender relations, having had more partners, and many more gender inequitable practices including transactional sex and physical partner violence. Also drug use, gang membership and a higher score on the dimensions of psychopathic personality, namely blame externalisation and Machiavellian egocentricity. Asked about why they did it, the most common motivations stemmed from ideas of sexual entitlement.

CONCLUSIONS

Perpetration of rape is so prevalent that population-based measures of prevention are essential to complement criminal justice system responses. Our findings show the importance of measures to build gender equity and change dominant ideas of masculinity and gender relations as part of rape prevention. Reducing men's exposure to trauma in childhood is also critically important.

Do trauma symptoms mediate the relationship between childhood physical abuse and adult child abuse risk?

OBJECTIVE

Although the intergenerational transmission of family violence has been well documented, the mechanisms responsible for this effect have not been fully determined. The present study examined whether trauma symptoms mediate the relationship between a childhood history of child physical abuse (CPA) and adult CPA risk, and whether any such mediation was similar for women and men.

METHOD

Female and male US Navy (USN) recruits (N=5,394) and college students (N=716) completed self-report measures of their history of child abuse (i.e., CPA and child sexual abuse [CSA]), exposure to intimate partner violence (IPV), current trauma symptoms, and adult CPA risk.

RESULTS

As expected, there was a strong association between a childhood history of CPA and adult CPA risk. This association was significant even after controlling for demographic variables and childhood exposure to other forms of violence (CSA and IPV), and the strength of the relationship did not vary depending on demographics or exposure to other forms of violence. However, the association between a history of CPA and adult risk of CPA was stronger for individuals high in defensive avoidance compared to those low in defensive avoidance. The association between a history of CPA and adult CPA risk was largely, although not entirely, mediated by psychological trauma symptoms. Mediation was observed for both women and men in both the USN and college samples.

CONCLUSIONS

Trauma symptoms associated with a history of CPA accounted for a substantial part of the relationship between a history of CPA and adult CPA risk in both women and men.

PRACTICE IMPLICATIONS

To the extent that trauma symptoms are a mechanism by which the intergenerational transmission of child abuse occurs, intervening to reduce trauma symptoms in CPA victims has the potential of reducing their risk of continuing the cycle of violence.

Male-to-female sexual aggression among Iraq, Afghanistan, and Vietnam veterans: co-occurring substance abuse and intimate partner aggression

The current study examined the frequency and correlates of coercive sexual behaviors by male Iraq, Afghanistan, and/or Vietnam veterans recruited from a Veterans Affairs trauma recovery clinic (n = 92) toward their female partners. Men who reported sexual aggression in the past year (n = 37) compared to men who did not report sexual aggression in the past year (n = 55) more frequently reported impulsive aggression, dominating/isolating, and physically assaulting their partner, and were more likely to have a substance abuse diagnosis. Sexually aggressive men were significantly less likely than nonsexually aggressive men to have a diagnosis of depression. Posttraumatic stress disorder, an established risk factor for nonsexual partner aggression among veterans, was not associated with sexual aggression.

Toward a multi-level, ecological approach to the primary prevention of sexual assault: prevention in peer and community contexts

Although sexual assault prevention programs have been increasingly successful at improving knowledge about sexual violence and decreasing rape-supportive attitudes and beliefs among participants, reducing sexually assaultive conduct itself remains an elusive outcome. This review considers efforts to support change for individuals by creating prevention strategies that target peer network and community-level factors that support sexual violence. To this end, the article examines successful ecological prevention models from other prevention fields, identifies the components of multilevel prevention that appear critical to efficacy and discusses their application to existing and emerging sexual violence prevention strategies.

A prospective analysis of the relationship between childhood sexual victimization and perpetration of dating violence and sexual assault in adulthood

The majority of studies evaluating the relationship between childhood sexual assault and subsequent sexual assault perpetration by men have been conducted retrospectively and with incarcerated populations. The present study seeks to improve on previous research by prospectively investigating the relationship between childhood sexual assault and subsequent perpetration of dating violence in adulthood in men. Although there is a significant relationship between childhood sexual abuse and history of sexual assault perpetration at baseline, prospective analyses indicate that childhood sexual assault is not predictive of perpetration during the follow-up period. The role of family factors, including parental conflict resolution, is implicated in subsequent sexual aggression. These results are supportive of the idea that the effects of childhood sexual abuse may be mediated by a variety of factors.

Cross-Sectional Predictors of Sexual Assault Perpetration in a Community Sample of Single African American and Caucasian Men

Computer-assisted self-interviews were completed with a random sample of 163 unmarried Caucasian and African American men in a large metropolitan area. Almost a quarter (24.5%) of these men acknowledged committing an act since the age of 14 that met standard legal definitions of attempted or completed rape; an additional 39% had committed another type of sexual assault involving forced sexual contact or verbal coercion. An expanded version of the Malamuth et al. [1991] confluence model was examined using path analysis. The number of sexual assaults perpetrated by participants was associated with the direct or indirect effects of childhood sexual abuse, adolescent delinquency, alcohol problems, sexual dominance, positive attitudes about casual sexual relationships, and pressure from peers to engage in sexual relationships. Additionally, empathy buffered the relationship between sexual dominance and perpetration. The pattern of results was highly similar for African American and Caucasian men. The implications of these findings for sexual assault measurement are discussed and suggestions are made for alternative treatment programs.

Seeking Safety Plus Exposure Therapy: An Outcome Study on Dual Diagnosis Men

This study arose out of a prominent clinical need: effective treatment for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in civilian men. This dual diagnosis is estimated to occur in up to 38% of men in substance abuse treatment, and generally portends a more severe clinical course than SUD alone. Clinical issues include self-harm, suicidality, perpetration of violence against others, and HIV risk behaviors. This study appears to be the first outcome trial to address a sample of civilian men with PTSD and SUD using manualized psychosocial treatment. It evaluates a novel combination treatment, Seeking Safety plus Exposure Therapy-Revised. The former is a coping skills treatment designed for PTSD and SUD; the latter is an adaptation of Foa's exposure therapy, modified for PTSD and SUD. In this small sample (n = 5) outpatient pilot trial, patients with current PTSD and current SUD were offered 30 sessions over five months, with the option to select how much of each type of treatment they preferred. Outcome results showed significant improvements in drug use; family/social functioning; trauma symptoms; anxiety; dissociation; sexuality; hostility; overall functioning; meaningfulness; and feelings and thoughts related to safety. Trends indicating improvement on 11 other outcome variables were also found. Treatment attendance, satisfaction, and alliance were extremely high. The need for further evaluation using more rigorous methodology is discussed.

Childhood trauma and adult prostitution behavior in a multiethnic heterosexual drug-using population

A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Among male subjects,higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men.

Science or propaganda?an examination of rind, tromovitch and bauserman (1998)

An article, &#0147;A Meta-analytic Examination of Assumed Properties of Child Sexual Abuse Using College Samples,&#0148; published in the July 1998 edition of the Psychological Bulletin resulted in an unprecedented amount of media attention and became the first scientific article to be formally denounced by the United States House of Representatives. The study's authors analyzed the findings of 59 earlier studies on child sexual abuse (CSA) and concluded that mental health researchers have greatly overstated CSA's harmful potential. They recommended that a willing encounter with positive reactions would no longer be considered to be sexual abuse; instead, it would simply be labeled adult-child sex. The study's conclusions and recommendations spawned a debate in both the popular and scholarly press. A number of commentators suggested that the study is pedophile propaganda masquerading as science. Others claimed that the authors are victims of a moralistic witch-hunt and that scientific freedom is being threatened. After a careful examination of the evidence, it is concluded that Rind et al. can best be described as an advocacy article that inappropriately uses science in an attempt to legitimize its findings.