Supporting Survivors of Military Sexual Trauma: The Imperative for Occupational Therapy in Research and Practice

Abstract

Military sexual trauma (MST) disrupts survivors’ lives, affecting identity, occupational roles, and relationships. Research often focuses on psychological outcomes, but this column emphasizes the unique contributions of occupational therapy to MST recovery. Taking an approach that is grounded in occupational science and trauma-informed care, I explore how MST affects daily functioning, self-perception, and relational trust. I argue for an expanded role for occupational therapy in supporting survivors through identity reconstruction, reengagement in meaningful roles, and relational repair. By addressing the lived realities of MST, occupational therapists can foster healing, empowerment, and occupational justice within trauma-responsive care systems.

This column emphasizes the unique contributions of occupational therapy to military sexual trauma recovery.

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References

Andresen

F. J.

Monteith

L. L.

Kugler

Cruz

R. A.

, & Blais

R. K.

(2019). Institutional betrayal following military sexual trauma is associated with more severe depression and specific posttraumatic stress disorder symptom clusters. Journal of Clinical Psychology, 75, 1305–1319. https://doi.org/10.1002/jclp.22773

Bourke

(2021). Military sexual trauma: Gender, military cultures, and the medicalization of abuse in contemporary America. Journal of War and Culture Studies, 15, 86–105. https://doi.org/10.1080/17526272.2021.1884785

Brownstone

L. M.

Holliman

B. D.

Gerber

H. R.

, & Monteith

L. L.

(2018). The phenomenology of military sexual trauma among women veterans. Psychology of Women Quarterly, 42, 399–413. https://doi.org/10.1177/0361684318791154

Campbell

Dworkin

, & Cabral

(2009). An ecological model of the impact of sexual assault on women’s mental health. Trauma, Violence, and Abuse, 10, 225–246. https://doi.org/10.1177/1524838009334456

Chu

Y.-C.

Wang

H.-H.

Chou

F.-H.

Hsu

Y.-F.

, & Liao

K.-L.

(2024). Outcomes of trauma‐informed care on the psychological health of women experiencing intimate partner violence: A systematic review and meta‐analysis. Journal of Psychiatric and Mental Health Nursing, 31, 203–214. https://doi.org/10.1111/jpm.12976

Chudzik

Corr

, & Santos

R. M.

(2023). “. . . We’re not doing enough:” Trauma-informed care in an early childhood special education center Topics in Early Childhood Special Education, 45, 43–55. https://doi.org/10.1177/02711214231219282

Cichowski

S. B.

Rogers

R. G.

Clark

E. A.

Murata

, & Murata

(2017). Military sexual trauma in female Veterans is associated with chronic pain conditions. Military Medicine, 182, e1895–e1899. https://doi.org/10.7205/MILMED-D-16-00393

Cloitre

Jackson

, & Schmidt

J. A.

(2016). Case Reports: STAIR for strengthening social support and relationships among Veterans with military sexual trauma and PTSD. Military Medicine, 181, e183–e187. https://doi.org/10.7205/MILMED-D-15-00209

Creech

S. K.

Kroll‐Desrosiers

Benzer

J. K.

Pulverman

C. S.

, & Mattocks

(2022). The impact of military sexual trauma on parent–infant bonding in a sample of perinatal women Veterans. Depression and Anxiety, 39, 201–210. https://doi.org/10.1002/da.23218

10.

Dhillon

S. K.

Wilkins

Law

M. C.

Stewart

D. A.

, & Tremblay

(2010). Advocacy in occupational therapy: Exploring clinicians’ reasons and experiences of advocacy. Canadian Journal of Occupational Therapy, 77, 241–248. https://doi.org/10.2182/cjot.2010.77.4.6

11.

Drescher

K. D.

Currier

J. M.

Nieuwsma

J. A.

McCormick

Carroll

T. D.

Sims

B. M.

, & Cauterucio

(2018). A qualitative examination of VA chaplains’ understandings and interventions related to moral injury in military Veterans. Journal of Religion and Health, 57, 2444–2460. https://doi.org/10.1007/s10943-018-0682-3

12.

Eschenfelder

V. G.

Gavalas

C. M.

Pendergast

T. M.

, & Gorman

C. A.

(2018). Expressive art to facilitate the development of the Occupational Profile: A scoping review. Open Journal of Occupational Therapy, 6, 8. https://doi.org/10.15453/2168-6408.1360

13.

Felder

, & Delany

P. J.

(2021). Life course perspective on the role of military sexual trauma as a pathway to homelessness for female Veterans. Journal of Military, Veteran and Family Health, 7(Suppl. 1), 69–75. https://doi.org/10.3138/jmvfh-2021-0029

14.

Freysteinson

W. M.

Mellott

Celia

Goff

Plescher

, & Allam

(2018). Body image perceptions of women Veterans with military sexual trauma. Issues in Mental Health Nursing, 39, 623–632. https://doi.org/10.1080/01612840.2018.1445327

15.

Gallagher

Muldoon

O. T.

, & Pettigrew

(2015). An integrative review of social and occupational factors influencing health and wellbeing. Frontiers in Psychology, 6, 1281. https://doi.org/10.3389/fpsyg.2015.01281

16.

Galovski

T. E.

Street

A. E.

Creech

Lehavot

Kelly

U. A.

, & Yano

E. M.

(2022). State of the knowledge of VA military sexual trauma research. Journal of General Internal Medicine, 37(Suppl. 3), 825–832. https://doi.org/10.1007/s11606-022-07580-8

17.

Goldberg

S. B.

Livingston

W. S.

Blais

R. K.

Brignone

Suo

Lehavot

, … Gundlapalli

A. V.

(2019). A positive screen for military sexual trauma is associated with greater risk for substance use disorders in women Veterans. Psychology of Addictive Behaviors, 33, 477–483. https://doi.org/10.1037/adb0000486

18.

Government of Canada. (2023). Sexual misconduct . https://www.canada.ca/en/department-national-defence/services/benefits-military/conflict-misconduct/sexual-misconduct.html

19.

Hannagan

R. J.

(2016). “I believe we are the fewer, the prouder”: Women’s agency in meaning-making after military sexual assault. Journal of Contemporary Ethnography, 46, 624–644. https://doi.org/10.1177/0891241616636664

20.

Hannan

S. M.

Thomas

K. B.

, & Allard

C. B.

(2021). Posttraumatic stress symptom severity mediates the relationship between military sexual trauma and tension reduction behaviors in male and female Veterans. Journal of Interpersonal Violence, 36, NP10035. https://doi.org/10.1177/0886260519864355

21.

Harricharan

McKinnon

M. C.

, & Lanius

R. A.

(2021). How processing of sensory information from the internal and external worlds shape the perception and engagement with the world in the aftermath of trauma: Implications for PTSD. Frontiers in Neuroscience, 15, 625490. https://doi.org/10.3389/fnins.2021.625490

22.

Hauck

Schestatsky

Terra

Kruel

, & Helena Freitas Ceitlin

(2007). Parental bonding and emotional response to trauma: A study of rape victims. Psychotherapy Research, 17, 83–90. https://doi.org/10.1080/10503300500477596

23.

Heber

Testa

Groll

Ritchie

Tam-Seto

Mulligan

, … Carleton

R. N.

(2023). Glossary of terms: A shared understanding of the common terms used to describe psychological trauma, Version 3.0. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy, and Practice, 43, S1–S999. https://doi.org/10.24095/hpcdp.43.10/11.09

24.

Hodgson

T. J.

Carey

L. B.

, & Koenig

H. G.

(2021). Moral injury, Australian Veterans and the role of chaplains: An exploratory qualitative study. Journal of Religion and Health, 60, 3061–3089. https://doi.org/10.1007/s10943-021-01417-0

25.

Ibbotson

A. A. M. M.

Imre-Millei

Orchard Young

S. T.

Held

N. J.

Ninan

R. M.

McKinnon

M. C.

, & Tam-Seto

(2025). Military cultural competency in Canadian sexual assault support centers: “Not here for lessons.” Journal of Social Service Research, 51, 1070–1081. https://doi.org/10.1080/01488376.2025.2489549

26.

Kelly

U. A.

(2021). Barriers to PTSD treatment-seeking by women Veterans who experienced military sexual trauma decades ago: The role of institutional betrayal. Nursing Outlook, 69, 458–470. https://doi.org/10.1016/j.outlook.2021.02.002

27.

Litz

B. T.

Plouffe

R. A.

Nazarov

Murphy

Phelps

Coady

, … Levi-Belz

; Moral Injury Outcome Scale Consortium .(2022). Defining and assessing the syndrome of moral injury: Initial findings of the Moral Injury Outcome Scale Consortium. Frontiers in Psychiatry, 13, 923928. https://doi.org/10.3389/fpsyt.2022.923928

28.

Lofgreen

A. M.

Carroll

K. K.

Dugan

S. A.

, & Karnik

N. S.

(2017). An overview of sexual trauma in the U.S. military. Focus, 15, 411–419. https://doi.org/10.1176/appi.focus.20170024

29.

Lopes

McKinnon

M. C.

, & Tam-Seto

(2023). Adding insult to injury: Exploring the relation between moral injury and military sexual trauma. Journal of Military, Veteran and Family Health, 9, 19–28. https://doi.org/10.3138/jmvfh-2022-0045

30.

Loyer

H. J.

(2014). Military sexual trauma: Policy analysis on Veterans’ benefits access in the past, present, and future. Federal Circuit Bar Journal, 24, 493.

31.

Marx

B. P.

, & Sloan

D. M.

(2005). Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy, 43, 569–583. https://doi.org/10.1016/j.brat.2004.04.004

32.

Mee

Sumsion

, & Craik

(2004). Mental health clients confirm the value of occupation in building competence and self-identity. British Journal of Occupational Therapy, 67, 225–233. https://doi.org/10.1177/030802260406700506

33.

Moye

O’Malley

K. A.

Auguste

E. J.

Driver

J. A.

Owsiany

M. T.

, & Paik

J. M.

(2023). Trauma re-engagement and PTSD in older medically ill Veterans: Implications for trauma-informed care. Aging and Mental Health, 27, 957–964. https://doi.org/10.1080/13607863.2022.2068135

34.

Muffly

, & Gerney

(2015). Occupational preferences of people who have experienced sexual assault. Occupational Therapy in Mental Health, 31, 101–112. https://doi.org/10.1080/0164212X.2015.1027842

35.

Precin

(2011). Occupation as therapy for trauma recovery: A case study. Work, 38, 77–81. https://doi.org/10.3233/WOR-2011-1106

36.

Raanaas

R. K.

Lund

Sveen

, & Asbjørnslett

(2019). Re-creating self-identity and meaning through occupations during expected and unexpected transitions in life. Journal of Occupational Science, 26, 211–218. https://doi.org/10.1080/14427591.2019.1592011

37.

Reeves

(2024). “He’s never been the same”: Children’s perception of moral injury in parents post military deployment. Journal of Military, Veteran and Family Health, 10, 142–151. https://doi.org/10.3138/jmvfh-2023-0083

38.

Restall

G. J.

, & Egan

M. Y.

(2021). Collaborative relationship–focused occupational therapy: Evolving lexicon and practice. Canadian Journal of Occupational Therapy, 88, 220–230. https://doi.org/10.1177/00084174211022889

39.

Smigielski

Reisenfeld

, & Prusnek

(2024). The impact and relevance of sensory modulation–related occupational therapy interventions on emotional regulation in preparation for readiness to change for individuals who are incarcerated and have experienced trauma. Occupational Therapy in Mental Health, 40, 489–510. https://doi.org/10.1080/0164212X.2024.2308289

40.

Stewart

K. E.

, Du Mont

Charise

, & Polatajko

H. J.

(2020). Life interrupted: A narrative exploration of the occupational lives of women who experienced sexual assault while at university. Journal of Occupational Science, 27, 492–509. https://doi.org/10.1080/14427591.2020.1773305

41.

Stewart

K. E.

Du Mont

, & Polatajko

H. J.

(2019). Applying an occupational perspective to women’s experiences of life after sexual assault: A narrative review. Journal of Occupational Science, 26, 546–558. https://doi.org/10.1080/14427591.2018.1516159

42.

Surìs

Lind

Kashner

T. M.

, & Borman

P. D.

(2007). Mental health, quality of life, and health functioning in women Veterans: Differential outcomes associated with military and civilian sexual assault. Journal of Interpersonal Violence, 22, 179–197. https://doi.org/10.1177/0886260506295347

43.

Tam-Seto

Garland-Baird

Held

Heber

Buchart

Ibbotson

, … McKinnon

M. (

2025). Critical Conversations: A restorative engagement initiative for people with lived experience of military sexual trauma. Journal of Military, Veteran and Family Health, 11, 42–52. https://doi.org/10.3138/jmvfh-2023-0105

44.

Torchalla

Killoran

Fisher

, & Bahen

(2019). Trauma-focused treatment for individuals with posttraumatic stress disorder: The role of occupational therapy. Occupational Therapy in Mental Health, 35, 386–406. https://doi.org/10.1080/0164212X.2018.1510800

45.

Townsend

E. A.

, & Polatajko

(2007). Enabling occupation II: Advancing an occupational therapy vision of health, well-being, and justice through occupation (2nd ed.). CAOT Publications.

46.

Twinley

(2017). Woman-to-woman rape and sexual assault, and its impact upon the occupation of work: Victim/survivors’ life roles of worker or student as disruptive and preservative. Work, 56, 505–517. https://doi.org/10.3233/WOR-172529

47.

Williamson

Murphy

Stevelink

S. A.

Jones

Allen

, & Greenberg

(2023). Family and occupational functioning following military trauma exposure and moral injury. BMJ Military Health, 169, 205–211. https://doi.org/10.1136/bmjmilitary-2020-001770

48.

Yalch

M. M.

Hebenstreit

C. L.

, & Maguen

(2018). Influence of military sexual assault and other military stressors on substance use disorder and PTS symptomology in female military Veterans. Addictive Behaviours, 80, 28–33. https://doi.org/10.1016/j.addbeh.2017.12.026

49.