It's normal to have upsetting memories, feel on edge, or have trouble sleeping after a traumatic event (also called "trauma"). At first, it may be hard to do daily activities you are used to doing, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months. For some people, PTSD symptoms may start later, or they may come and go over time.

If it's been longer than a few months and thoughts and feelings from the trauma are upsetting you or causing problems in your life, you may have PTSD.

Who Develops PTSD?

Anyone can develop PTSD at any age. Some factors can increase the chance that someone will have PTSD, many of which are not under that person's control. For example, having a very intense or long-lasting traumatic event or getting injured during the event can make it more likely that a person will develop PTSD. PTSD is also more common after certain types of trauma, like combat and sexual assault.

Personal factors—like previous traumatic exposure, age, and gender—can affect whether or not a person will develop PTSD. What happens after the traumatic event is also important. Stress can make PTSD more likely, while social support can make it less likely.

What Are the Symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.

There are 4 types of PTSD symptoms, but they may not be exactly the same for everyone. Each person experiences symptoms in their own way.

1. Reliving the event (also called re-experiencing symptoms). Memories of the traumatic event can come back at any time. They can feel very real and scary. For example:
   • You may have nightmares.
   • You may feel like you are going through the event again. This is called a flashback.
   • You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing fireworks are examples of triggers.
2. Avoiding things that remind you of the event. You may try to avoid situations or people remind you of the trauma event. You may even avoid talking or thinking about the event. For example:
   • You may avoid crowds, because they feel dangerous.
   • You may avoid driving if you were in a car accident or if your military convoy was bombed.
   • If you were in an earthquake, you may avoid watching movies about earthquakes.
   • You may keep very busy or avoid getting help so you don't have to think or talk about the event.
3. Having more negative thoughts and feelings than before the event. The way you think about yourself and others may become more negative because of the trauma. For example:
   • You may feel numb—unable to have positive or loving feelings toward other people—and lost interest in things you used to enjoy.
   • You may forget about parts of the traumatic event or not be able to talk about them.
   • You may think the world is completely dangerous, and no one can be trusted.
   • You may feel guilt or shame about the event, wishing you had done more to keep it from happening.
4. Feeling on edge or keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. You might suddenly become angry or irritable. For example:
   • You may have a hard time sleeping.
   • You may fiind it hard to concentrate.
   • You may be startled by a loud noise or surprise.
   • You might act in unhealthy ways, like smoking, abusing drugs or alcohol, or driving aggressively.

What Are the Symptoms of PTSD in Children?

Children may have symptoms like those above or other symptoms. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children and teens:

• Children under 6 may get upset if their parents are not close by, have trouble sleeping, or act out the trauma in their play.
• Children ages 7 to 11 may also act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
• Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.

Do People With PTSD Get Better?

After a traumatic event, it's normal to think, act, and feel differently than usual—but most people start to feel better after a few weeks or months. Talk to a doctor or mental health care provider (like a psychiatrist, psychologist, or social worker) if your symptoms:

• Last longer than a few months
• Are very upsetting
• Disrupt your daily life

"Getting better" means different things for different people. There are many different treatment options for PTSD. For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense. Your symptoms don't have to interfere with your everyday activities, work, and relationships.

What Treatments Are Available?

Both trauma-focused psychotherapy (sometimes called counseling or talk therapy) and medication are proven to treat PTSD. Sometimes people combine psychotherapy and medication.

Trauma-Focused Psychotherapy

Trauma-focused psychotherapy are the most highly recommended treatment for PTSD. "Trauma-focused" means, that the treatment focuses on the memory of the traumatic event or its meaning. The 3 most effective types of trauma-focused psychotherapy are:

• Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.
• Prolonged Exposure (PE) where you talk about your trauma repeatedly until memories are no longer upsetting. This will help you get more control over your thoughts and feelings about the trauma. You also go to places or do things that are safe, but that you have been staying away from because they remind you of the trauma.
• Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma. This helps your brain work through the traumatic memories.

Medications for PTSD

Certain medications can be effective for treating PTSD symptoms. Some specific SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), which are used for depression, also work for PTSD. These include sertraline, paroxetine, fluoxetine, and venlafaxine.

Years ago, little was known about PTSD in infants and young children. Today, we know that trauma and abuse can have grave impact on the very young. We also know how much the attachment or bond between a child and parent matters as a young child grows. This can make a difference in how a child responds to trauma. Below we discuss rates of trauma-related problems in infants and young children, as well as treatment options.

How Many Infants and Young Children Are Abused?

In the United States, Child Protective Services receives reports on the abuse or neglect of about 5.5 million children in a year. Infants and young children have more risk of abuse than older children. Over one-third of proven reports to child protection services are for children under the age of five years. Further, children are most often hurt or killed from abuse when they are in the first year of life. Over three-quarters of children killed due to abuse are under the age of three years.

How Do Trauma and Neglect Affect Infants and Young Children?

As with adults, following trauma, most children will have some symptoms. Young children may show a fear of strangers or be scared to leave their parent. They might also have sleep problems or bad dreams. Young children may also repeat themes of the trauma in their play. For example, a child who was sexually abused in her bed might play out "dark" bedroom scenes with dolls. They might also be more fussy, irritable, aggressive, or reckless. Young children may lose skills they once had, such as toilet training. They might go back to earlier habits, like sucking their thumb. Very young children may not show the same PTSD symptoms we see in adults. This may be because many of the symptoms of PTSD require that the child be able to talk about what happened.

Early trauma affects the child's nervous system. The nervous system is shaped by the child's experiences. Stress over a period of time can lead to changes in the parts of the brain that control and manage feelings. That is to say, stress and trauma early in life can change the brain. This can have long-term effects on physical, mental, and emotional growth. What's more, the impact of early abuse often extends into later childhood, teen, and even adult years.

Diagnosing PTSD in Infants and Young Children

Although most children have symptoms following trauma, only a few will go on to get PTSD. Diagnosing PTSD in children can be difficult. The definition of trauma that is used to diagnose PTSD is specific. It says that a person must feel fear, helplessness, or horror for an event to be a "trauma." It is hard to say if this happens for a very small child. Young children are often not able to describe in words the event or how they felt about it. For this reason, other ways of diagnosing PTSD have been created for use with children ages zero to three years.

What Is Attachment?

Attachment is the connection found in the main relationship in a child's life. Usually it is with his or her caregiver. Children and parents are meant to form attachments with each other. For example, your baby is born knowing how to cuddle and cry, and it causes you to respond. Also, infants like their caregiver's face and voice more than other sights and sounds. The type of attachment between a child and caregiver can affect how a child will relate to the people she or he comes across in life.

Why Is Attachment Important When Dealing with Trauma?

A child's main attachment helps him learn to control his emotions and thoughts. When a caregiver's responses are in tune with a child's needs, the child feels secure. The child then uses this relationship pattern as practice to build coping skills. On the other hand, a child who gets confusing or inconsistent responses from the caregiver might be fussy, have a hard time calming down, withdraw from others, or have tantrums.

Children also use their caregivers to guide how they should respond to events. Have you noticed how a child sometimes looks at his or her parent to know how to respond? When you stop your child from doing something unsafe, he in time learns to stop himself. So a parent's reaction to trauma affects the child. Through a relationship with their caregiver, children learn how to be in charge of feelings and behaviors, and how to act with other people.

Here are some examples:

• If a caregiver often helps a child manage her feelings, the child can build coping skills. This could lead to better healing for children who go through trauma.
• A traumatic event might hurt the attachment between a caregiver and child due to strong feelings that get in the way of a good relationship. Sometimes a child can be angry toward her parent for not keeping her safe. Even very young children can have these feelings. Or, a parent might feel guilty about the event and this might affect the relationship.
• If the caregiver has her own trauma history, her symptoms (trying not to feel, always worried about danger) might get in the way of caring for her child.

What Kind of Help Is Out There?

• Child health care settings, doctors, and other health care providers can give support, education, safety planning, and information about treatment.
• Child and family social services can help caregivers with many issues.
• In-home nurses and other providers can help new parents provide good care for their young children. They might help with feeding, sleep, safety, or illness.
• Therapy is needed if relationship problems or PTSD symptoms do not get better. Treatment that involves the caregiver and child together is best for cases with poor attachment and trauma. One such treatment is called child-parent psychotherapy (CPP). CPP helps caregivers understand their children, keep them safe, and give emotional help.
• For some children, treatment does not take place for many years. No matter the age, when trauma and PTSD are involved, evidence-based, effective treatments exist.

Stressors

Combat Service members are at risk for death or injury. They may see others hurt or killed. They may have to kill or wound others. They are on alert around the clock. These and other factors can increase their chances of having PTSD or other mental health problems.

For many Service members, being away from home for long periods of time can cause problems at home or work. These problems can add to the stress.

This may be even more so for National Guard and Reserve troops who had not expected to be away for so long. Almost half of those who served in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) have been Guard and Reservists.

Another cause of stress is military sexual trauma (MST). This is sexual assault or repeated, threatening sexual harassment that occurs in the military. It can happen to men and women. MST can occur during peacetime, training, or war.

Mental Health Effects of Serving in Afghanistan and Iraq

The wars in Afghanistan and Iraq are the longest combat operations since Vietnam. Many stressors face these Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) troops. One early study looked at the mental health of these Service members. The study asked Soldiers and Marines about war-zone experiences and about their symptoms of distress. Soldiers and Marines in Iraq reported more combat stressors than Soldiers in Afghanistan. This table describes the kinds of stressors faced in each combat theater in 2003:

Soldiers and Marines who had more combat stressors had more mental health problems. Those who served in Iraq had higher rates of PTSD than those who served in Afghanistan.

Later research has confirmed that to date, troops who served in Iraq are more likely to report mental health problems than troops who served in Afghanistan. A body of research shows a strong link between level of combat stress and PTSD.

How Does Serving in OEF/OIF Affect Mental Health?

Research on OEF/OIF Veterans (1) suggests that 10% to 18% of OEF/OIF troops are likely to have PTSD after they return. In addition to PTSD, OEF/OIF Service members are at risk for other mental health problems. Although studies vary widely in terms of methods used, estimates of depression in returning troops range from 3% to 25%. Excessive drinking and use of tobacco among OEF/OIF Veterans may also be problematic. Service members also report concerns over conflicts with others.

Some research has looked at how the response to war stressors changes over time. PTSD symptoms are more likely to show up in returning OEF/OIF Service members after a delay of several months. Using a brief PTSD screen, Service members were assessed at their return and then again six months later. Service members were more likely to have a positive screen - that is, they showed more PTSD symptoms - at the later time.

On the other hand, many Service members who screened positive (had more PTSD symptoms) at their return showed fewer PTSD symptoms after six months. Overall, it should be noted that most returning Service members screened negative for PTSD at both time points.

What Increases the Risk of PTSD in OEF/OIF Service members?

Research studies have found that certain factors make it more likely that OEF/OIF Service members will develop PTSD. These factors include:

• Longer deployment time
• More severe combat exposure, such as:
  • Deployment to "forward" areas close to the enemy
  • Seeing others wounded or killed
• More severe physical injury
• Traumatic brain injury
• Lower rank
• Lower level of schooling
• Low morale and poor social support within the unit
• Not being married
• Family problems
• Member of the National Guard or Reserves
• Prior trauma exposure
• Female gender
• Hispanic ethnic group

The COVID-19 pandemic creates stressors like fear about getting sick, concern for loved ones, isolation, job loss and new childcare and family demands. If you have been through traumatic events in the past, you may have learned to cope well in crisis situations. However, dealing with the pandemic is unique; some ways people cope—like eating out or watching or playing sports—may not be an option. For those with PTSD, the pandemic may trigger or affect your PTSD symptoms.

PTSD Symptoms Can Be Affected by the COVID-19 Pandemic

PTSD affects many aspects of life. It may cause you to feel anxious, unsafe and on high alert. It may make you less interested or less willing to do things most people consider safe. With PTSD, you may see the world as dangerous or worry about your ability to handle difficult situations. Trusting others and being intimate with others can be challenging.

Here are some ways the pandemic can further affect PTSD-related symptoms and difficulties:

• Feeling more on guard or unsafe. Health and safety are concerns for everyone during this time. If you have PTSD, these concerns might be more intense and frequent than for others. You may want to avoid other people more than usual or find that you are extremely worried about getting the virus. Places that felt safe before the pandemic may now cause you to feel anxious. You may also find that you have an even stronger urge to avoid being in open public places. And, you may feel more "keyed up" than usual, even about things other than COVID-19.
• More trauma triggers. You may find that you are experiencing more triggers or reminders of your trauma. Hearing others talk about the pandemic as if we are fighting a war, or a battle with COVID-19 or an invisible enemy may bring up uncomfortable feelings and memories. For people, whose trauma involved difficulty breathing, wearing masks or seeing others do so may remind them of that event.
• Not doing things that are still considered safe. There may include things you cannot do right now because of COVID-19. However, if you find that you are not doing things that are considered safe, it may be because of your PTSD. This may include things like taking care of your health and basic needs like shopping or exercising. Or it may be things you used to enjoy like spending time outdoors, watching movies and catching up with friends and family via telephone or video chat.
• An increase in negative thoughts and feelings. You might have more negative thoughts right now, especially thoughts that may be connected to COVID-19. For example, you might think: "I can't trust others to do the right thing," or "I have no control over anything." Or you may find you feel guilt or shame because the virus is changing your ability to do important things for yourself or others. You may feel angrier and more irritable, especially if you cannot do activities that normally help you blow off steam. You may also have a short fuse with your loved ones because you are together more than usual and out of your normal routines.
• Problems with sleep and concentration. You may find it more difficult to concentrate and do the things that helped you focus before the pandemic. Added worry and stress can make it difficult for you to get good sleep. You may find it harder than usual to fall sleep or stay asleep if you are worrying more or your PTSD symptoms get more severe.

Tips for Healthy Coping

Coping skills you normally use, or learned in treatment, that have helped you in the past may be harder to practice during the pandemic. These suggestions may help you find ways to cope:

• Get PTSD treatment. There are a number of PTSD treatments that have been shown to work. Treatment for your PTSD can also lead to improved functioning and quality of life. Getting PTSD treatment now can help you cope with the additional stressors of COVID-19. Learn more about PTSD treatments.
• Do activities that feel meaningful to you. Doing things that mean something to you and you enjoy can have a big impact on your mood. Try safely connecting with family members and friends, learning a new hobby, supporting your children in their schoolwork or spending time outside.
• Use good self-care skills. Try to focus on the things you can control rather than the things you can't control. Be kind to yourself; the pandemic affects everyone. Avoid using alcohol, tobacco, or drugs; this kind of negative coping can make things worse in the long run. Instead, try keeping a routine, getting good sleep and eating healthy to help manage your stress.
• Reach out for help. If you see a therapist or other mental health professional or have seen one in the past, reach out to them for support during this time. You may find you need only a few meetings to get back on track with your recovery. It may be possible to continue treatment by telephone or video. Talk to your mental health provider to determine the best option for you. If you are feeling overwhelmed:
  • Call or text 988 anytime to talk with a crisis counselor at the Suicide and Crisis Lifeline
    You can also open a live, online chat on their website.
  • If you are a Veteran, you can reach the Veterans Crisis Line by calling 988, then pressing 1. You can also text 838255 or visit their website to open a live, online chat.
  • Call the National Domestic Violence Hotline: 1-800-799-SAFE (7233).
  • You can also call 911 for emergency services or go to your local emergency room for immediate medical care.

IPV refers specifically to violence and aggression between intimate partners. IPV can include physical, sexual or psychological abuse or stalking. Acts of IPV range in how often they occur or how violent they are. It can happen to women or men who have intimate relationships with women, men or both. It can happen no matter your age, income, race, ethnicity, culture, religion, or disability.

IPV includes, but is not limited to, any of the following:

• Physical violence: hitting, pushing, grabbing, biting, choking/strangulating, shaking, slapping, kicking, hair-pulling, restraining
• Sexual violence: attempted or actual sexual contact when the partner does not want to or is unable to consent (for example, when affected by alcohol or illness)
• Threats of physical or sexual abuse: ways to cause fear through words, looks, actions or weapons
• Psychological or emotional abuse: name calling, humiliating, putting you down, keeping you from friends and family, bullying, controlling where you go or what you wear
• Stalking: following, harassing, or unwanted contact that makes you feel afraid

Some people experience only one of these forms of violence while others experience many types of violence. IPV can be a single event or last for many years. No matter what, no one deserves to be treated this way.

What Are Some Relationship Red Flags?

Relationships can be complicated in general. A relationship with IPV can be overwhelming and confusing. Sometimes it can be hard to know if you have experienced IPV. The following questions give some examples of unsafe behaviors that can happen in a relationship.

• Does your partner control all of the family income and budget? Control your work or your schooling?
• Does your partner keep you away from friends and family? Control you by questions and threats about what you do, where you go, and people you see?
• Does your partner put you down, or make you feel guilty or ashamed? Blame you for the abuse?
• Does your partner make or carry out threats to hurt your body or your feelings, or those of someone you love? Threaten to ruin your reputation? Threaten to take your children away?
• Does your partner scare you by breaking or destroying objects, or punching holes in walls? Hurting or threatening pets?
• Does your partner physically hurt you or try to hurt you?
• Does your partner force you to engage in sexual activities?
• Does your partner threaten to commit suicide or kill you if you leave the relationship?

If you answered yes to any of these questions, your health and safety may be at risk. Help is available. Take a look at the resources listed below and know that you can get help if and when you are ready.

How Do I Know When I Am in a Healthy Relationship?

Some people who are in relationships with IPV may not have had much experience in safe, healthy relationships. They may not believe that healthy safe relationships actually exist. While no relationship is perfect, here are some behaviors that are commonly found in healthy relationships:

• Your partner supports your relationships with friends and family members.
• Your partner asks your opinion and respectfully listens to your answers. You and your partner can agree to disagree and resolve conflicts without fear of name calling, insults, manipulation, threats, or violence.
• Your partner accepts responsibility for his or her own mistakes, behavior, thoughts, or feelings and will offer sincere apologies and work to change accordingly.
• Your partner trusts you, is trustworthy and is someone you and your children feel safe with.
• You share in the decision making, the responsibility of family budgeting, and sharing the family resources to benefit all family members.

If you find that you would like to build or increase these behaviors in your current and future relationships, you may consider consulting with a health care professional about how to find support in doing so.

How Common Is IPV?

You are not alone. IPV can happen to anyone no matter how much education or money they have. In the United States, about 1 in 4 women (or 27%) and 1 in 10 men (or 11%) report having been harmed by sexual or physical violence, or by stalking by an intimate partner at some point in their lives.

How Might IPV Affect Me?

You may not realize it, but the impact of IPV can reach far beyond the actual or threatened violence or aggression. Much of the research looks at female victims of IPV, but the findings are generally true for men as well. Here are some examples:

Physical health:

• Experiencing IPV may mean that you have more physical health problems. For example, women who experienced IPV are twice as likely to have a chronic illness and five times as likely to have coronary heart disease. Women who have experienced IPV are also twice as likely to have chronic neck or back pain or stomach problems such as irritable bowel syndrome.
• IPV may also increase your exposure to sexually transmitted diseases, such as chlamydia and human immunodeficiency virus (HIV).
• Women who have experienced IPV may also have more female health problems.

Psychological health:

• Experiencing IPV may mean that you have more problems with your mood. IPV can lead to depressed mood, feelings of worthlessness, anxiety or worry, feeling emotionally numb (such as difficulty feeling your emotions or connecting with others emotionally), problems with alcohol or drugs, or suicidal thoughts and behavior. You might also feel "stressed out," "on edge" or have feelings of guilt or shame.
• Your health care provider may assess you for posttraumatic stress disorder (PTSD), substance abuse, anxiety and depression.

Social health:

• Experiencing IPV may also affect your job or career as well as your living situation. For example, women who have experienced IPV may have a harder time keeping their job and be more likely to become homeless.
• Some people who experience IPV may feel uncomfortable or unsafe in new relationships and/or have difficultly trusting people.

It may be hard to talk about these experiences. It is normal to get upset when discussing IPV or worrying what others may think. Remember that it is not your fault.

Staying Safe

Only you know what is safest for you and your children. What you may do to keep yourself safe may change over time, but safety planning is something you can do now to help improve your safety situation. Some important safety practices include:

• If you think that you or your children are in danger, leave the situation right away.
• Make a note of safe places within your home to go when conflicts begin to heat up. Avoid rooms with weapons (such as the kitchen) or with no exits (such as closets, bathrooms).
• Consider finding a code word to use as a distress signal to family members, children, and friends. Inform them in advance that if they hear you use the code word, they should get help right away.
• Pack a suitcase with items to take with you when you leave. Make copies of important legal documents (such as driver's license, social security cards, birth certificates, medical records showing previous injuries) and set some money aside. Hide these items in a place where your partner will not find them.
• Make a list of people and agencies you can call or go to in case of an emergency. Learn key phone numbers (such as the number for your local shelter, even if you think you won't need it). Memorize the National Domestic Violence Hotline (see below).
• Talk with someone you trust. Even if you do not want to discuss the details of your situation, simply telling one person that you trust that you have experienced IPV and that you may need their support in the future can help.
• Consider talking to neighbors about calling police for you if they hear loud noises or fighting.
• Consider explaining your situation to your supervisor at work so that they might be able to help you with safety planning in your workplace.

Getting Support

Many people who have experienced IPV have a hard time talking about it. Experiencing IPV can bring up feelings of shame and low self-esteem. These feelings can make it hard to seek help or reach out to others for support. Also, since violent partners often try to control and keep their partners away from their loved ones, experiencing IPV can make you feel alone. If you have been threatened, even indirectly, with harm to you or your loved ones, you might feel afraid of what could happen if you tell about your experiences or try to get help. It can take a lot of time and courage to decide to seek help.

Remember that although you cannot stop your partner's behavior (only he or she can do that), you can find support for yourself and your children. Stay connected to friends and family who support your health and safety. Also, many professional resources and providers are available and well-trained to help you in a private and respectful manner. For example, you can talk to any of your health care providers about what is going on in your relationship and learn about additional supports and services available to you.

How Can Friends and Family Help?

Friends and family often worry about their loved ones who are in unsafe, fearful situations. They sometimes wonder how they might be able to help. Here are some suggestions for friends and family:

• Listen to and believe the IPV experience of your friend or family member.
• Explain that no one deserves to be abused or battered by their partner. Explain that it is the abusive partner who is solely to blame and who is entirely responsible for their own behavior.
• Share that you continue to be worried about the safety of your friend or family member and any children in the family.
• Express that you care about your friend or family member no matter what. Let them know you will help support them when they are ready to leave the relationship or to seek professional help.

Research with Women Veterans

Some research suggests that women Veterans and active duty military personnel are even more likely than non-Veterans to have experienced IPV. Among women Veterans receiving health care in VA, between 3 to 7 of every 10 (or 30% to 70%) report having experienced IPV at some point in their lives. In active duty women, more than 3 in every 10 (or 36%) report having experienced one or more types of IPV during their service.

MST is the term used by the Department of Veterans Affairs (VA) to refer to experiences of sexual assault or sexual harassment that a Veteran experienced during their military service. VA is strongly committed to ensuring that Veterans have access to the help they need in order to recover from MST.

What Is MST?

MST includes any sexual activity during military service where a Veteran was involved against their will. They may have been:

• Pressured into sexual activities (for example, with threats of negative consequences for refusing to be sexually cooperative or with implied better treatment in exchange for sex)
• Unable to consent to sexual activities (for example, when intoxicated or asleep)
• Physically forced into sexual activities

Other experiences that fall into the category of MST include:

• Unwanted sexual touching or grabbing, including during "hazing" experiences
• Offensive remarks about a person's body or sexual activities that they found threatening
• Unwelcome sexual advances that a person found threatening

The identity or characteristics of the perpetrator, whether a Veteran was on or off duty at the time, and whether they were on or off base at the time do not matter.

How Common Is MST?

VA's national screening program, in which every Veteran seen for health care is asked whether they experienced MST, provides data on how common MST is among Veterans seen in VA.

National data from this program reveal that about 1 in 3 women and 1 in 50 men respond "yes," that they experienced MST, when screened by their VA provider. Although rates of MST are higher among women, because there are many more men than women in the military, there are actually significant numbers of women and men seen in VA who have experienced MST. In fact, over 1 of every 3 Veterans who tell a provider they experienced MST are men.

It is important to keep in mind that these data speak only to the rate of MST among Veterans who have chosen to seek VA health care; they cannot be used to make an estimate of the actual rates of sexual assault and harassment experiences among all individuals serving in the U.S. Military.

How Can MST Affect Veterans?

Like other forms of trauma, MST can be a life-changing event. However, people are often remarkably resilient after experiencing MST. MST is an experience, not a diagnosis or a mental health condition, and there are a variety of reactions that Veterans can have in response to MST. Many individuals recover without professional help. Others may generally function well in their lives but continue to experience some level of difficulties or have strong reactions in certain situations. For some Veterans, the experience of MST may continue to affect their mental and physical health in significant ways, even many years later.

The type, severity and duration of a Veteran's difficulties will vary based on factors like:

• Whether they have experienced other traumatic events
• Whether the MST happened once or was repeated over time
• The types of responses they received from others at the time of the MST

Gender, race/ethnicity, religion, sexual orientation and other cultural variables can also affect the impact of MST. Although every Veteran's reaction following MST is unique, many Veterans may struggle with similar issues. Some of the experiences many survivors of MST may have at some point include:

• Strong emotions: having intense, sudden emotional responses to things; feeling angry or irritable all the time; feeling depressed
• Feelings of numbness: feeling emotionally "flat"; difficulty experiencing emotions like love or happiness
• Trouble sleeping: trouble falling or staying asleep; disturbing nightmares
• Difficulties with attention, concentration, and memory: trouble staying focused; frequently finding their mind wandering; having a hard time remembering things
• Problems with alcohol or other drugs: drinking to excess or using drugs daily; getting intoxicated or "high" to cope with memories or emotional reactions; drinking to fall asleep
• Difficulty with things that remind them of their experiences of sexual trauma: feeling on edge or "jumpy" all the time; difficulty feeling safe; going out of their way to avoid reminders of their experiences
• Difficulties with relationships: feeling isolated or disconnected from others; difficulty trusting others; trouble with employers or authority figures; abusive relationships; difficulties with intimacy or sex
• Physical health problems: chronic pain; weight or eating problems; gastrointestinal problems

Posttraumatic stress disorder (PTSD) is one of the most common mental health diagnoses among MST survivors. Other mental health diagnoses that are frequently related to MST include depression and other mood disorders and substance use disorders. MST has also been found to be associated with a variety of physical health conditions.

Fortunately, people can recover from experiences of trauma, and VA has effective services to help Veterans do this.

What MST-Related Services Does VA Offer?

VA is strongly committed to ensuring that Veterans have access to the help they need in order to recover from MST.

• Every VA health care facility has a designated MST Coordinator who serves as a contact person for MST-related issues. This person can help Veterans find and access VA services and programs.
• Recognizing that many survivors of sexual trauma do not disclose their experiences unless asked directly, VA health care providers ask every Veteran whether they experienced MST. This is an important way of making sure Veterans know about the services available to them.
• All treatment for physical and mental health conditions related to experiences of MST is provided free of charge.
• Veterans do not need to be service connected (or have a VA disability rating). Veterans do not need to have reported the incident(s) at the time or have other documentation that they occurred to get care.
• Veterans may be able to receive this care even if they are not eligible for other VA care.
• MST-related services are available at every VA medical center and many VA community-based outpatient clinics.
• MST-related outpatient counseling is also available through VA's community-based Vet Centers.
• MST-related services are designed to meet Veterans where they are at in their recovery, whether that is focusing on strategies for coping with challenging emotions and memories or, for Veterans who are ready, discussing the impacts of their MST experiences in more detail with a trusted provider. Veterans can ask to meet with a clinician of a particular gender if it would help them feel more comfortable.
• For Veterans needing more intensive treatment and support, VA also provides MST-related mental health treatment in residential or inpatient settings.

For self-care, you can also download Beyond MST, a free mobile app that was created for survivors of MST to cope with MST-related challenges and improve health, relationships and quality of life.

Racial trauma can negatively affect physical, mental and emotional health, and in some cases, lead to PTSD. This information may be useful for those who experience discrimination or trauma based upon other aspects of identity, such as gender, sexuality, religion, etc.

What Is Racial Trauma?

Racial trauma refers to the emotional impact of stress related to racism, racial discrimination, and race-related stressors, such as being affected by stereotypes, hurtful comments, or barriers to advancement. Racial trauma can refer to a specific incident of racial discrimination or the ongoing, harmful emotional impact of racial discrimination that builds up over time. People can experience racial trauma from something that happens directly to them or from seeing others mistreated because of their race. Coverage of events caused by racial discrimination in the media can also be upsetting, and repeated viewing or frequent media accounts can amplify those feelings.

What Are the Impacts of Racial Trauma?

Racial trauma can lead to an increased risk of physical and mental health problems. Emotional difficulties, such as stress, anxiety, depression or PTSD, can impact daily functioning in school, work or at home. Relationships with others may also be affected; people may worry that others dismiss their concerns about racial trauma. It is normal and understandable to be negatively affected by racial trauma.

How Can Racial Trauma Incidents Lead to PTSD?

Racial trauma incidents that involve actual or threatened death, serious injury or sexual violence may lead to PTSD. Any experiences of racial trauma can make existing PTSD and other mental health problems worse. There are many similarities between PTSD symptoms and symptoms related to the emotional impacts of racial trauma. After experiencing racial discrimination, people may have unwanted memories and may avoid thoughts, feelings and reminders of racial trauma. In addition, racial trauma can lead to negative thoughts about oneself, others and the world, and contribute to negative moods. Finally, people may feel on guard and on high alert, and have trouble with concentration, sleep or irritability due to racial trauma.

Coping With Racial Trauma

Racial trauma is a broad problem that requires communities to work together to overcome it. At times, coping with racial trauma can feel overwhelming, so focusing on strategies for empowerment and healing can be helpful. Coping may not reduce or stop racial trauma, but taking active steps can help people reduce stress and let them redirect their focus back to living fulfilling lives.

For those people who continue to feel distressed, consider talking to a health care provider. Talking to a mental health provider can be helpful for people who are feeling overwhelmed, having difficulties with relationships, or struggles with day-to-day functioning at work, school or household responsibilities.

Conclusion

Racial trauma can negatively affect physical, mental and emotional health, and in some cases, lead to PTSD. If self-care is not enough to cope with the impact of racial trauma in daily life, seeking professional help can be valuable. A mental health provider can help to assess the negative impacts of racial trauma and to work with people to identify effective coping and treatment strategies. Some VA facilities offer Race-Based Stress and Trauma Empowerment groups designed to treat racial stress and trauma. Evidence-based talk therapies for PTSD—like Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) and Eye-Movement Desensitization and Reprocessing (EMDR)—can help to treat PTSD due to racial trauma.

While this article focuses on the impact of racial trauma, the information may also apply to discrimination or trauma due to other aspects of identity, such as sexual orientation, gender identity, religion, spirituality, ability status, socioeconomic status, age or generation.

• Empowerment. Racial trauma can lead to feelings of helplessness. Focusing on ways to take control or have an influence can improve emotional health. Empowerment strategies can range from self-care to speaking up about issues that are important. Some people may find advocacy for reducing discrimination or oppression meaningful.
• Values-based goal setting. Identifying specific goals that align with personal values (e.g. family, community, equity, self-improvement, security) can be another way to feel more in control and enjoy life.
• Self-care and lifestyle changes. Taking time to recuperate from racial trauma on a regular basis is important. Taking walks, listening to music or relaxation techniques may help. The specific activity is not important. The goal is to choose something that helps to reduce stress.
• Taking charge of emotions. Relaxation and mindfulness strategies can be helpful in countering the effects of stress on the body and mind.
• Social support. Talking to supportive others about thoughts and feelings related to racial trauma can be validating.
• Media balance. While staying informed about current events is important, it may be helpful to limit exposure to "doomscrolling," or focusing on negative and discouraging media content.

"A nation is not conquered until the women's hearts lay on the ground." - Cheyenne Indian saying

In war, rape is not just an assault on the woman. It is also an assault on her family and community. Many hundreds of thousands of women have been raped in wars just in the past few decades. Reports have come from all over the world - from Korea, Bangladesh, Liberia, Southeast Asia, Uganda, and more places. Refugees from Bosnia have described how military forces publicly raped women. This was to force families to flee their villages, with the goal of "ethnic cleansing."

Conservative estimates of the number of women raped during the Bosnian war are between 20,000 and 50,000. Estimates of sexual assault rates range from 3% to 6% in Bosnian refugee women. Posttraumatic stress symptoms were found in up to 75% of Bosnian refugees. In Darfur rates of rape are difficult to establish. Some estimate, though, that 10,000 girls and women have been raped each year since 2003.

Assaults are often gang-related and sadistic. They may include other forms of physical torture. The assault survivors may also lose their home and community if they are forced to move. They may suffer injury and illness as a result of the assault. These women may also witness the murder, injury, or rape of loved ones. The effects of these types of trauma cannot be measured. They are long lasting and shattering to both inner and outer worlds.

In some cases, the way the culture views rape can make things even worse. In Muslim culture, for example, the honor of the woman reflects upon the entire family. Rape is thought to be shameful. A woman who is raped might fear being expelled from her husband's family or never finding a husband. Some rape victims might also believe that they are being punished for some sin that they have committed. Even if they do not blame themselves, they may feel such a strong duty to protect their family that they often stay silent about the trauma. Many of the Bosnian rape victims told no one about what happened to them. Stigma and injustice have surrounded the rape of women for as long as time. In fact, rape was not labeled a crime against humanity or war crime until the 1990s.

Child sexual abuse includes a wide range of sexual behaviors that take place between a child and an older person. These behaviors are meant to arouse the older person in a sexual way. In general, no thought is given to what effect the behavior may have on the child. For the most part, the abuser does not care about the reactions or choices of the child.

Child sexual abuse often involves body contact. This could include sexual kissing, touching, and oral, anal, or vaginal sex. Not all sexual abuse involves body contact, though. Showing private parts ("flashing"), forcing children to watch pornography, verbal pressure for sex, and exploiting children as prostitutes or for pornography can be sexual abuse as well. Researchers estimate that in our country about one out of six boys and one out of four girls are sexually abused.

Under the child sexual abuse laws, the abuser must be older than the victim in most cases. Some states require the abuser to be at least five years older.

Who Commits Child Sexual Abuse?

• Most often, sexual abusers know the child they abuse, but are not family. For example, the abuser might be a friend of the family, babysitter, or neighbor. About 6 out of 10 abusers fall into that group.
• About 3 out of 10 of those who sexually abuse children are family members of the child. This includes fathers, uncles, or cousins.
• The abuser is a stranger in only about 1 out of 10 child sexual abuse cases.
• Abusers are men in most cases, whether the victim is a boy or a girl.
• Women are the abusers in about 14% of cases reported against boys and about 6% of cases reported against girls.
• Child pornographers and other abusers who are strangers may make contact with children using the Internet.

What Are the Effects of Childhood Sexual Abuse?

It is not always easy to tell whether a child has been sexually abused. Sexual abuse often occurs in secret, and there is not always physical proof of the abuse. For these reasons, child sexual abuse can be hard to detect.

Some child sexual abuse survivors may show symptoms of PTSD. They may behave in a nervous, upset way. Survivors may have bad dreams. They may act out aspects of the abuse in their play. They might show other fears and worries. Young children may lose skills they once learned and act younger than they are. For example, an abused child might start wetting the bed or sucking his or her thumb. Some sexual abuse survivors show out-of-place sexual behaviors that are not expected in a child. They may act seductive or they may not maintain safe limits with others. Children, especially boys, might "act out" with behavior problems. This could include being cruel to others and running away. Other children "act in" by becoming depressed. They may withdraw from friends or family. Older children or teens might try to hurt or even kill themselves.

Sexual abuse can be very confusing for children. For a child, it often involves being used or hurt by a trusted adult. The child might learn that the only way to get attention or love is to give something sexual or give up their self-respect. Some children believe the abuse is their fault somehow. They may think the abuser chose them because they must have wanted it or because there is something wrong with them. If the abuser was of the same sex, children (and parents) might wonder if that means they are "gay."

Almost every child sexual abuse victim describes the abuse as negative. Most children know it is wrong. They usually have feelings of fear, shock, anger, and disgust. A small number of abused children might not realize it is wrong, though. These children tend to be very young or have mental delays. Also some victims might enjoy the attention, closeness, or physical contact with the abuser. This is more likely if these basic needs are not met by a caregiver. All told, these reactions make the abuse very hard and confusing for children.

If childhood sexual abuse is not treated, long-term symptoms can go on through adulthood. These may include:

• PTSD and anxiety.
• Depression and thoughts of suicide.
• Sexual anxiety and disorders, including having too many or unsafe sexual partners.
• Difficulty setting safe limits with others (e.g., saying no to people) and relationship problems.
• Poor body image and low self-esteem.
• Unhealthy behaviors, such as alcohol, drugs, self-harm, or eating problems. These behaviors are often used to try to hide painful emotions related to the abuse.

If you were sexually abused as a child and have some of these symptoms, it is important for you to get help.

What Can Caregivers Do to Help Keep Children Safe?

Although caregivers cannot protect their children 100% of the time, it is important to get to know the people that come around your child.

Most importantly, provide a safe, caring setting so children feel able to talk to you about sexual abuse. Other tips to keep your children safe include:

• Talk to others who know the people with whom your child comes in contact.
• Talk to your children about the difference between safe touching and unsafe touching.
• Tell the child that if someone tries to touch his or her body in their private areas or do things that make the child feel unsafe, he should say NO to the person. He needs to tell you or a trusted adult about it right away.
• Let children know that their bodies are private and that they have the right not to allow others to touch their bodies in an unsafe way.
• Let them know that they do not have to do EVERYTHING the babysitter, family member, or group leader tells them to do.
• Alert your children that abusers may use the Internet. Watch over your child on the Internet.

What Should You Do if You Think Your Child Has Been Sexually Abused?

If a child says she or he has been abused, try to stay calm. Reassure the child that what happened is not her fault, that you believe her, that you are proud of her for telling you (or another person), and that you are there to keep her safe. Take your child to a mental health and medical professional right away. Many cities have child advocacy centers where a child and her family can get help. These centers interview children and family members in a sensitive, warm place. They can help you report the abuse to legal authorities. They can help you find a medical examiner and therapist skilled in child sexual abuse.

Children can recover from sexual abuse and go on to live good lives. The best predictor of recovery is support and love from their main caregiver. As a caregiver, you might also consider getting help for yourself. It is often very hard to accept that a child has been sexually abused. You will not be supporting your child, though, if you respond in certain unhelpful ways. For example, you will not be able to provide support if you are overwhelmed with your own emotions. Don't downplay the abuse ("it wasn't that bad"), but also try not to have extreme fears related to the abuse ("my child will never be safe again"). It will not help children if you force them to talk, or if you blame the child. Getting therapy for yourself can help you deal with your own feelings about the abuse. Then you might be better able to provide support to your child.

Estimates vary, but studies suggest that about 13% of women have experienced a sexual assault at some time during their lives. Estimates for women experiencing child sexual abuse are higher, with 27% of women reporting this experience. In some samples (e.g., Veterans and current military), these rates tend to be higher.

What Is Sexual Assault?

Sexual assault is defined as any sort of sexual activity between two or more people in which one of the people is involved against his or her will.

The sexual activity involved in an assault can include many different experiences. Women can be the victims of unwanted touching, grabbing, oral sex, anal sex, sexual penetration with an object, and/or sexual intercourse.

There are a lot of ways that women can be involved in sexual activity against their will. The force used by the aggressor can be either physical or non-physical. Some examples of how women are forced or pressured into having sex include being:

• taken advantage of by someone who has some form of authority over them (for example doctor, teacher, boss)
• bribed or manipulated into sexual activity against her will
• unable to give her consent because she is under the influence of alcohol or drugs
• threatened to be hurt or that people that she cares about will be hurt
• physically forced or violently assaulted

Who Commits Sexual Assaults?

Often, when we think about who commits sexual assault or rape, we imagine the aggressor is a stranger to the victim. Contrary to popular belief, sexual assault does not typically occur between strangers. The National Crime Victimization Survey, conducted by the U.S. Department of Justice, found that about four of every five sexually assaulted women were attacked by a current or former husband, cohabitating partner, friend, or date. Strangers committed only about one of every five of the assaults that were reported in this survey.

How Often Do Sexual Assaults Happen?

Estimating rates of sexual violence against women is a difficult task. Many factors stop women from reporting these crimes to police and to interviewers collecting statistics on the rate of crime in our country. Women may not want to report that they were assaulted because it is such a personal experience, because they blame themselves, because they are afraid of how others may react, and because they do not think it is useful to make such a report. However, there are statistics that show sexual assault is a problem in our country. For example:

• A large-scale study conducted on several college campuses found that one of every five women reported that they had been raped in their lifetime.
• The National Crime Victimization Survey estimated that one half of a million (or 500,000) sexual assaults occurred in the U.S. in one year, from 1992 to 1993. Of those assaults, about three of ten were completed rapes and an additional three of ten were attempted rapes.

What Happens to Women after They Are Sexually Assaulted?

After a sexual assault, women can experience a wide range of reactions. It is very important to note that there is no single pattern of response. Some women respond immediately, others may have delayed reactions. Some women are affected by the assault for a long time, but others appear to recover more quickly.

In the time just after a sexual assault, many women report feeling shock, confusion, anxiety, and/or numbness. Sometimes women will experience feelings of denial. In other words, they may not fully accept what has happened to them or they may downplay the intensity of the experience. This reaction may be more common among women who are assaulted by someone they know.

What Are Some Early Reactions to Sexual Assault?

In the first few days and weeks following the assault, it is very normal for a woman to experience intense and sometimes unpredictable emotions. She may have repeated strong memories of the event that are difficult to ignore, and nightmares are not uncommon. Women also report having difficulty concentrating and sleeping, and they may feel jumpy or on edge. While these initial reactions are normal and expected, some women may have severe, highly disruptive symptoms that make it very difficult to function in the first month following the assault. When these problems disrupt the woman's daily life, and prevent her from seeking assistance or telling friends and family members, the woman may have.

What Are Some Other Reactions that Women Have Following a Sexual Assault?

Major Depressive Disorder (MDD)

Depression is a common reaction following sexual assault. Symptoms of MDD can include a depressed mood, an inability to enjoy things, difficulty sleeping, changes in patterns of sleeping and eating, problems in concentration and decision-making, feelings of guilt, hopelessness, and decreased self-esteem. Research suggests that almost one of every three rape victims have at least one period of MDD during their lives. And for many of these women, the depression can last for a long period of time. Thoughts about suicide are also common. Studies estimate that one in three women who are raped contemplate suicide, and about one in ten rape victims actually attempt suicide.

Anger

Many victims of sexual assault report struggling with anger after the assault. Although this is a natural reaction to such a violating event, there is some research that suggests that prolonged, intense anger can interfere with the recovery process and further disrupt a woman's life.

Shame and guilt

These feelings are common reactions to sexual assault. Some women blame themselves for what happened or feel shameful about being an assault victim. This reaction can be even stronger among women who are assaulted by someone that they know, or who do not receive support from their friends, family, or authorities following the incident. Shame and guilt can also get in the way of a woman's recovery by preventing her from telling others about what happened and getting assistance.

Social problems

Social problems can sometimes arise following a sexual assault. A woman can experience problems in her marital relationship or in her friendships. Sometimes an assault survivor will be too anxious or depressed to want to participate in social activities. Many women report difficulty trusting others after the assault, so it can be difficult to develop new relationships. Performance at work and school can also be affected.

Sexual problems

Sexual problems can be among the most long-standing problems experienced by women who are the victims of sexual assault. Women can be afraid of and try to avoid any sexual activity. Or, they may experience an overall decrease in sexual interest and desire.

Alcohol and drug use

Substance abuse can sometimes become problematic for women who are the victims of assault. A large-scale study found that compared to non-victims, rape survivors were three to four times more likely to use marijuana, six times more likely to use cocaine, and ten times more likely to use other major drugs. Often, women will report that they use these substances to control other symptoms related to their assault.

PTSD

Posttraumatic Stress Disorder (PTSD) involves a pattern of symptoms that some individuals develop after experiencing a traumatic event such as sexual assault. Symptoms of PTSD include repeated thoughts of the assault; memories and nightmares; avoidance of thoughts, feelings, and situations related to the assault; negative changes in thought and feelings; and increased arousal (for example difficulty sleeping and concentrating, jumpiness, irritability). One study that examined PTSD symptoms among women who were raped found that almost all (94 out of 100) women experienced these symptoms during the two weeks immediately following the rape. Nine months later, about 30 out of 100 of the women were still reporting this pattern of symptoms. The National Women's Study reported that almost one of every three all rape victims develop PTSD sometime during their lives.

What Should I Do if I Have Been Sexually Assaulted? Where Can I Go for Help?

If you were sexually assaulted and are experiencing symptoms that are distressing to you, or symptoms that are interfering with your ability to live a full life, we urge you to talk to a health care provider or mental health professional. Depending on the type of problems you are having, a number of therapies may be helpful to you.

The treatment you receive will depend on the symptoms you are experiencing and will be tailored to your needs. Some therapies involve talking about and making sense of the assault in order to reduce the memories and pain associated with the assault. Attending therapy may also involve learning skills to cope with the symptoms associated with the assault. Finally, therapy can help survivors restore meaning to their lives.

Unfortunately, sexual assault is fairly common in our society today. Survivors of sexual assault can experience a wide variety of symptoms, but they do not have to suffer in silence. Mental health professionals can offer a number of effective treatments tailored to the individual woman's needs. We urge you to seek help today.

At least 1 out of every 10 (or 10%) of men in our country have suffered from trauma as a result of sexual assault. Like women, men who experience sexual assault may suffer from depression, posttraumatic stress disorder (PTSD), and other emotional problems as a result. However, because men and women have different life experiences due to their different gender roles, emotional symptoms following trauma can look different in men than they do in women.

Who Are the Perpetrators of Male Sexual Assault?

• Those who sexually assault men or boys differ in a number of ways from those who assault only females.
• Boys are more likely than girls to be sexually abused by strangers or by authority figures in organizations such as schools, the church, or athletics programs.
• Those who sexually assault males usually choose young men and male adolescents (the average age is 17 years old) as their victims and are more likely to assault many victims, compared to those who sexually assault females.
• Perpetrators often assault young males in isolated areas where help is not readily available. For instance, a perpetrator who assaults males may pick up a teenage hitchhiker on a remote road or find some other way to isolate his intended victim.
• As is true about those who assault and sexually abuse women and girls, most perpetrators of males are men. Specifically, men are perpetrators in about 86 out of every 100 (or 86%) of male victimization cases.
• Despite popular belief that only gay men would sexually assault men or boys, most male perpetrators identify themselves as heterosexuals and often have consensual sexual relationships with women.

What Are Some Symptoms Related to Sexual Trauma in Boys and Men?

Particularly when the assailant is a woman, the impact of sexual assault upon men may be downplayed by professionals and the public. However, men who have early sexual experiences with adults report problems in various areas at a much higher rate than those who do not.

Emotional disorders

Men and boys who have been sexually assaulted are more likely to suffer from PTSD, anxiety disorders, and depression than those who have never been abused sexually.

Substance abuse

Men who have been sexually assaulted have a high incidence of alcohol and drug use. For example, the probability for alcohol problems in adulthood is about 80 out of every 100 (or 80%) for men who have experienced sexual abuse, as compared to 11 out of every 100 (or 11%) for men who have never been sexually abused.

Risk taking behavior

Exposure to sexual trauma can lead to risk-taking behavior during adolescence, such as running away and other delinquent behaviors. Having been sexually assaulted also makes boys more likely to engage in behaviors that put them at risk for contracting HIV (such as having sex without using condoms).

Help for Men Who Have Been Sexually Assaulted

Men who have been assaulted often feel stigmatized, which can be the most damaging aspect of the assault. It is important for men to discuss the assault with a caring and unbiased support person, whether that person is a friend, clergyman, or clinician. However, it is vital that this person be knowledgeable about sexual assault and men.

A local rape crisis center may be able to refer men to mental-health practitioners who are well-informed about the needs of male sexual assault victims. If you are a man who has been assaulted and you suffer from any of these difficulties, please seek help from a mental-health professional who has expertise working with men who have been sexually assaulted.