After Assaults

At Veterans Affairs hospitals, more women seek treatment for sexual trauma.

"The most difficult part of my job is that I have so much job security," says Anne Sadler, coordinator of the post-traumatic stress clinical team at the Veterans Affairs hospital in Iowa City, Iowa. She specializes in treating women veterans who are victims of sexual trauma and, unfortunately, her office has been busy. "I wish that violence toward women was decreasing, but we're not seeing a decrease," Sadler says.

Sexual trauma has become an increasingly significant issue for VA because it affects women disproportionately, and the population of female veterans is growing rapidly. In 1982, there were 740,000; now there are 1.7 million. "The VA is an institution that has faced the challenge of changing a health care system that used to be oriented toward men to integrate women," Sadler says. The agency began treating women for sexual trauma, which includes harassment, assault, rape and other violence, after the passage of the 1992 Veterans Health Care Act. In 1994, it expanded sexual trauma counseling to men, and now provides such counseling at all its hospitals and many of its vet centers.

The number of women seeking mental health treatment at the Iowa City VA hospital has roughly doubled during the past year. When Sadler began her VA career in 1992, she spent most of her time treating men for combat stress. Now the majority of her patients are women who suffer from combat trauma, sexual trauma or both. "When people are traumatized, be it combat or sexual assault, the vast majority develop post-traumatic stress disorder," Sadler says. PTSD is a chronic condition, and those who have it have high rates of emotional and medical problems, including depression, substance abuse, panic disorder, chronic pain, hypertension and diabetes.

Recently, the Pentagon has taken steps to prevent sexual assault. In April 2004, its Task Force on Care for Victims of Sexual Assaults reported on how to prevent such incidents and help victims. In January, the Pentagon released new sexual assault policies required by the 2005 Defense Authorization Act. Critics say VA needs more resources to adequately meet the need for counseling. "The expertise in responding to PTSD and sexual violence issues isn't universally held across the country," says Deborah Tucker, executive director of the National Center on Domestic and Sexual Violence in Austin, Texas. "You have to live in a certain place to get the services."

Of those who have sought care at VA's health facilities since March 2002, about 36,000 women (20 percent) and 40,000 men (1 percent) said they experienced sexual trauma while serving in the military. The actual rate of occurrence is probably much higher as most sexual trauma is never reported.

It's unclear whether rates of sexual assault are higher in the military than in the general population. "On the one hand, the military population is very young, and the vast majority of sexual assault occurs in people under 25," Tucker says. The average age of active-duty forces is 28. "On the other hand, [military sexual assault] is severely underreported through official channels," she says. Eighteen percent of women in the general population have been victims of rape or attempted rape, according to the 1995 and 1996 "National Violence Against Women" surveys, sponsored by the National Institute of Justice and the Centers for Disease Control and Prevention.

In a 2003 study published in the American Journal of Industrial Medicine, for which Sadler was the lead researcher, 28 percent of women veterans surveyed said they had been raped while in the military. The study identified risk factors for military sexual assault, including officers who condone or allow sexual harassment and unwanted sexual attention. Most of the previous research had focused on risk factors associated with the victim, such as youth. "What's important about our study is that we can identify specific risk factors for violence, the most powerful of which were organizational," Sadler says. "You can make interventions to address those risks."