Treating Males who Disclose Sexual Assault: A Primer for Providers

Continuum of Harm - arrow with sexual Harrassment on one end and Sexual Assault on the other end.  Crude jokes, Sexual comments, Vulgar pictures, Seducctive behavior or inappropriate advances, Touching pinching, Groping, Threats, Blackmail, Sexual bribes, Physical force, Sexual fondling, Forcible assault
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By Holly N. O’Reilly, Ph.D.
April 16, 2018

During Sexual Assault Awareness Month, we take the opportunity to speak openly about Defense Department efforts to prevent sexual assault and sexual harassment, as well as clinical treatment for service members who’ve experienced sexual assault. This includes a commitment to preventing and treating male sexual assault. This blog will provide information on prevalence rates, challenge some common misperceptions, and provide links to evidence-based practice for treating men who’ve been sexually assaulted.

Prevalence of male sexual assault

While female service members’ risk of sexual assault is higher than male service members, more men are sexually assaulted each year due to men comprising a much higher percentage of the total force. According to Sexual Assault Prevention and Response Office (SAPRO) fiscal year 2016 data, an estimated 0.6 percent of male service members (6,300 men) had experienced some form of sexual assault in the past year. This estimate had decreased from 0.9 percent (10,600 men) in 2014.

What is unique to male service members who’ve been sexually assaulted?

The RAND Military Workplace Study, which surveyed nearly 560,000 U.S. service members, found that:

  • Men are more likely to describe a sexual assault as “hazing” or “bullying”
  • Men are more likely to report the assault was intended to humiliate or shame them
  • Most men reported that they were assaulted by multiple assailants and they are more likely to be physically injured in addition to being sexually assaulted

Common myths about male sexual assault

There are a number of myths about male sexual assault, which can discourage reporting and limit access to treatment. I’ve listed several common myths along with some thoughts about challenging such myths.

“Men don’t get raped.”

Anyone can be sexually assaulted. Regardless of gender, physical strength, size or skill, assaults still happen. I liken this to an ambush, ambushes often work because they leverage the element of surprise.

“Male on male rape is about homosexuality.”

Sexual assault is about power and control, not passion and sexual attraction. In my clinical experience, some men may question their sexuality, fearing that they somehow ”gave off a vibe” that it was okay or that they were sexually interested in the assailant(s). Sexual assault is unrelated to sexual orientation. Being sexually assaulted by someone of the same gender does not make you gay or lesbian. Likewise, being sexually assaulted by someone of the opposite gender does not make you heterosexual.

“Men can’t be raped by women.”

Although it is rare, men can be sexually assaulted by a woman or multiple women. Male physiological response is only partially under voluntary control. According to physiological studies, males may have an arousal response during times of extreme stress and/or in the absence of sexual pleasure or desire.

“If he allowed it to happen, he was okay with the assault.” or “He should have fought harder.”

Men may be unable to “fight back” for a number of reasons, including being outnumbered or being assaulted by someone in a position of authority. They may assess the risk of fighting back and realize that surviving the assault is the primary goal. Also, tonic immobility is a term used to describe a temporary form of paralysis, which may occur during a physical or sexual assault. When in a state of tonic immobility, it is nearly impossible to move and many people are temporarily unable to speak.  

Possible clinical implications

  • I would like to underscore the fact that men often label sexual assault as hazing. Clinicians should use terms such as hazing or bullying when questioning men about their trauma history. Also, take special notice when patients report that their workplace or co-workers are hostile or aggressive, as this may be an indication that they are at risk for assault. These aggressive behaviors are consistent with a range of inappropriate actions, such as sexist jokes, hazing, cyber bullying, that are used before or after an assault, referred to as the continuum of harm. For example, lewd comments at work about “oil checks” or “card swipes” may be precursors to a physical assault. Advise patients to speak with their immediate supervisor when such statements are made in the workplace so that corrective actions can be taken. If their immediate supervisor is responsible for the statements, they may need to go up the chain of command.
  • Many survivors of assault blame themselves for not doing more to prevent the assault or may interpret their physiological response as being meaningful. It may be helpful to provide your patient information regarding tonic immobility and the possibility of physical response without pleasure after they disclose a sexual assault.
  • Following sexual assault, some men may question their masculinity and make efforts to appear more masculine or reassert their masculinity. This may take numerous forms including augmenting their workout regimen or engaging in extreme workouts or engaging in more sexual activity (especially with casual partners or in high-risk situations) in an effort to “confirm” their masculinity. Be aware of this possibility and encourage them to avoid high-risk activities.

What other clinical implications are you aware of? Comments are welcome below.

Treatment options

Evidence-based effective treatment options for mental health concerns following a sexual assault don’t vary based on gender, although researchers are exploring whether gender-specific mental health treatments for both males and females who have experienced sexual assault are more or less effective than current evidence-based treatments. Remember, sexual assault is an event, not a diagnosis. More information about evidence-based treatment options for psychological health conditions and DoD efforts to address the mental health needs of those who have experienced sexual assault is available on our website.

Additional resources for sexual assault and sexual harassment in the military

O’Reilly is a contracted clinical psychologist and evidence-based practice subject matter expert at the Psychological Health Center of Excellence. Her specialties include the consequences of traumatic exposure and gender studies. 

 


The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


Comments

  • I'm far from certain that female-perpetrated sexual assault of men is quite as "rare" a phenomenon as the author suggests. Lara Stemple and Ilan H. Mayer of the UCLA School of Law, examining data last year from the Bureau of Justice Statistics, the CDC's annual surveys and four years' worth of the National Crime Victimization Survey's findings, noted that these revealed female perpetration in at least 35% of cases of rape or sexual assault reported by male victims. Recent campus-climate surveys by colleges and universities across the United States are yielding results in a similar range, with male victims indicating that their assailants were female in anywhere from around a third to more than a half of cases. Though her sample size is smaller, Siobhán Weare of Lancaster University has also brought to light, in an article published five months ago, significant levels of female-perpetrated rape on the other side of the Atlantic.

    While much work in this area remains to be accomplished, sufficient evidence exists to indicate that perceptions of the rarity of female-perpetrated sexual offending may owe more to a failure to look for it, or to take notice of it when it occurs, than the existence of an unusually low prevalence rate. Not so long ago, it was common to assert with much conviction that male rape in general was all but unknown outside correctional institutions -- a factor that contributed greatly to its invisibility. It would not do to be similarly dogmatic today, perhaps with no less damaging consequences, about its female-perpetrated subset.

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