Male Sexual Assault 1

Male Sexual Assault

SSS: 655

Social Work Response to Trauma

Jane Slomski April, 2010

Male Sexual Assault 2 Introduction The sexual abuse of women has received increased public attention since the womens movement of the 1960s. Policymakers have passed such legislation as the Violence Against Women Act (VAWA, 1994), and have enacted mandatory arrest laws for domestic violence cases. Meanwhile, the sexual abuse of men is a largely unresearched area of trauma that affects the lives of many men. Although there has been increased awareness in recent years, there is little to no recognition and little support for men who are survivors of sexual assault. A review of the literature suggests that sexual violence against men is a largely unrecognized and underreported area of trauma. Current research highlights the need for clinical interventions and treatment approaches that address the unique experiences of men affected by sexual violence. These men are a substantial group and deserve the mental health communitys full attention. Most researchers believe that in addition to the trauma reactions seen in women with a history of sexual abuse, the western societal values that surround being male, and manliness contribute to mens unwillingness to disclose and seek treatment for sexual assault or abuse. The feelings of helplessness, guilt, and overwhelming emotions that often surround these experiences are directly contrary to how society tells men they should behave (Allagia & Millington, 2008). Current societal values and beliefs that contribute to this gap as well as the current state of professional literature on the topic are addressed. Recommendations for policy and practice that may educate policymakers and social work practitioners and improve services to this population in the mental health field are discussed.

Male Sexual Assault 3 Literature Review The current literature on sexual assault is overwhelmingly focused on men as the perpetrators of sexual violence and on women as their victims. Certainly this is due to the fact that the majority of perpetrators are male (Kia-Keating, Sorsoli, & Grossman, 2009). However, sexual violence perpetrated against men by both male and female perpetrators occurs with more frequency than previously acknowledged by either clinical literature, or by society at large (Light & Monk-Turner, 2009). Only recently has society begun to acknowledge that men can be victims of sexual assault. It is currently estimated that men are the victims of sexual assault or rape in approximately 5-10 percent of reported cases every year (Light & Monk-Turner, 2009). However, these figures should be interpreted with caution, since not surprisingly, men are less likely than women to report being the victims of sexual violence (Light & Monk Turner, 2009). Common Reactions to Sexual Assault Over the past few decades, the traumatic impact of sexual assault in general has been well documented by clinicians and researchers alike, but male victims have not received the same amount of attention as female victims (Grossman, Sorsoli & Kia-Keating, 2006). Regardless of gender, several reactions to sexual assault appear to be common. Victims experience shame, guilt, fear of intimacy and physical contact with others, and may become triggered by previously neutral stimuli they associate with the event, such as physical places or sounds. Shame and guilt often prevent survivors from reporting the trauma in a timely manner that would allow for prosecution of the perpetrator (Rumney, 2008). Many victims report that law enforcement officials are untrained in interviewing victims of sexual violence and that they feel that law enforcement does not believe them. Law enforcement personnel report that they are not trained on how to handle cases involving male victimization (Rumney, 2008). Long-term physical and

Male Sexual Assault 4 emotional complaints include nightmares, flashbacks, somatic complaints (headaches, intestinal problems), and development of symptoms of anxiety and depressive disorders (Sorsoli, KiaKeating, & Grossman, 2008). Although it does not develop in all survivors of sexual assault, clinicians should screen carefully for clinical and sub-clinical levels of the symptoms of posttraumatic stress disorder (Alaggia & Millington, 2008). Post-traumatic Stress Disorder and Sexual Assault According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR, 2000) post-traumatic stress disorder (PTSD) is a severe anxiety disorder that may develop when a person has been exposed to an event that threatened death, serious injury, or the physical integrity of self or others. The persons reaction is characteristically intense helplessness, horror, or fear (APA, 2000). Although all survivors of sexual assault are at risk for developing symptoms of PTSD, some research suggests that men are more likely than women to develop the disorder in response to sexual trauma because of societal expectations of men and the taboo nature of male sexual assault in clinical settings and law enforcement (Rumney, 2008; Sorsoli, Kia-Keating & Grossman, 2008). Increased shame, threat of the loss of ones masculine identity, and denial of the existence of such trauma at the societal level discourages men from disclosing their experiences to either trusted others or professionals, and therefore hinders the process of healing for these survivors (Sorsoli, Kia-Keating & Grossman, 2008). The Unique Experiences of Men and Male Sexual Assault Research has shown that not surprisingly, societal beliefs, values, and stereotypes about gender and gender roles influence the way that men and male victims of sexual assault view themselves and view their traumatic experience (Light & Monk-Turner, 2009). The Federal

Male Sexual Assault 5 Bureau of Investigations Uniform Crime Report does not formally acknowledge that men can be the victims of forcible rape as it is defined as the carnal knowledge of a female [emphasis added] forcibly against her will (Light & Monk-Turner, 2009). In western society, children are taught from an early age how to behave in accordance with gender roles. Men are socialized to be aggressive, stoic, and unemotional. Emotion is a sign of weakness (Kia-Keating, Grossman, Sorsoli, & Epstein, 2005). In general, societal views of men and conventional masculinity perpetuate the myth that men cannot be victims of sexual assault (Andersen, 2008). As men are conditioned from a young age to desire sex and to pursue sexual gratification, society is led to believe that there is never a situation in which a man would refuse a sexual encounter (Andersen, 2008). Also pervasive are the myths that mens physical strength and stature prevent them from being the victims of violent or sexual crime, that men who are survivors of sexual assault are gay, that male rape only occurs in penitentiaries, and that a man should be able to protect himself from any unwanted advances (Light & Monk-Turner, 2009). For male victims of sexual assault, these societal beliefs and values are taught to young boys from an early age and become incorporated into their identities, leading to psychological and emotional barriers in dealing with the traumatic even that happened to them (Alaggia & Millington, 2008). In addition to the shame and guilt experienced by female survivors, male survivors report fears that others will view them as not only weak, but as unmanly or in some cases homosexual (Alaggia & Millington, 2008). Experiences of fear, helplessness, and vulnerability that are normative reactions to the experience of sexual victimization do not fit into societys definition of what it means to be male. The expression of these emotions associated with feminine qualities and experiences is discouraged (Alaggia & Millington, 2008).

Male Sexual Assault 6 Therefore, these men feel that they must defend not only their experience of sexual trauma, but also their masculinity. These beliefs and values are perpetuated by society and adopted by law enforcement and even the mental health community. Men are understandably hesitant to disclose their experiences because of the fear that they will not be believed, and may even be ridiculed for what happened to them (Rumney, 2008; Sorsoli, Kia-Keating & Grossman, 2008). Another societal factor that contributes to the minimization of the sexual victimization of males is the reluctance of society to see women as perpetrators of sexual violence (Denov, 2004). Society dictates that young men should enjoy the attention of older, more sexually experienced women. In many situations, men are proud of this attention and are taught to view it as a type of initiation into sex, rather than as a form of sexual abuse (Sorsoli, Kia-Keating, & Grossman, 2008). In general, research has found that society and helping professionals (police officers, social workers, etc.) view sexual or physical abuse by women as less harmful than abuse perpetrated by men. In one study, identical case scenarios were presented to social workers and police officers involved with child protective services. One scenario involved a female perpetrator of sexual abuse; the other involved a male perpetrator. The professionals were more likely to suggest child protective services intervention in the case involving the male perpetrator (Denov, 2004). It follows that law enforcement and other helping professionals may discredit men who have been sexually victimized by women. In addition, male (and female) children who are abused by female offenders are less likely to receive intervention by child protective services (Denov, 2004). Impact of Male Childhood Sexual Abuse The experience of sexual assault is further complicated if the trauma happened in childhood. As with females, males who experience the trauma of sexual assault or abuse in childhood often

Male Sexual Assault 7 experience a myriad of issues as adults, including intimacy problems, emotional discomfort, feelings of alienation, anger, and difficulties forming emotionally healthy relationships as adults. In addition, it has been found that the level of clinical symptomology experienced by boys who have been victims of sexual assault is generally higher than the level of symptomology experienced by females. Sexually abused boys are more likely to exhibit externalizing behaviors such as alcoholism, truancy, criminal behavior, drug use, and suicide attempts. Girls are more likely to internalize their emotions and develop anxiety, depression, and somatic complaints (Allagia & Millington, 2008; Andersen, 2008; Lemelin, 2006; Sorsoli, Grossman & Kia-Keating, 2008). Kia-Keating, Grossman, Sorsoli, & Epstein (2005) report that in part, the childhood sexual abuse of males (MCSA) is perpetuated and underreported because of the way our society socializes male children. Boys are not taught to express their emotions and are in fact taught to suppress them. In one study, Sorsoli, Kia-Keating & Grossman (2008) reported that men identified several barriers to disclosure of sexual abuse as children including lack of cognitive awareness, intentional avoidance, difficulty articulating thoughts and emotions surrounding the event, emotional readiness and safety, and shame. These men overwhelmingly reported that they had compartmentalized the traumatic events, and thus, lack of cognitive awareness had made it impossible for them to disclose about the traumatic experience. Further, these men reported that as they became adults and the trauma remained undisclosed, more shame developed out of the idea that they should tell someone and the idea that they were too weak or cowardly to tell anyone (Sorsoli, Kia-Keating, & Grossman, 2008). Adult Mens Experiences of Sexual Assault

Male Sexual Assault 8 Most of the research done around the sexual assault of men has been done on incarcerated populations (Willis, 2009). The sexual assault of men in other settings has only recently received greater attention from the academic community. This may be due to mens hesitance to report rape in other environments. Men are 1.5 times less likely to report rape than women (Willis, 2009). In one qualitative study, a self-identified gay man who experienced male perpetrated rape while in a bar reported on his experiences with first responders, medical professionals, and investigators (Willis, 2009). When he was examined at a hospital following the assault, a doctor advised him not to report the incident to police because there had been drugs and alcohol involved. The man had been given a date-rape drug and was disoriented during the assault (Willis, 2009). When he confided in a trusted friend about the assault, she told him that he was never careful enough (Willis, 2009). This mans experiences in disclosing to professionals and friends demonstrate two of the major reasons that men cite for not reporting incidents of sexual victimization: fear of being blamed for the assault and fear of not being believed, or being discredited (in this case due to the involvement of drugs and alcohol). Similarly to male adult survivors of childhood sexual abuse, survivors of sexual assault in adulthood report difficulty trusting in intimate relationships, post-traumatic stress disorder symptoms, mood disorders, including depression and anxiety, increased substance use and abuse, and occasional suicidality (Tiet, Finney, & Moos, 2006). Not surprisingly, men who experience rape as adults and have a history of childhood physical or sexual abuse are more likely to develop psychological and emotional symptoms than survivors without a history of abuse (Tiet, Finney, & Moos, 2006). Treatment

Male Sexual Assault 9 When treating male survivors of sexual assault, the social work practitioner must consider personal, relational, and societal factors that will impact treatment. In some cases, psychoeducation around the topic of male physiological arousal is useful, especially if the man experienced an erection during the assault. He may mistakenly believe that if he experienced arousal, he secretly wanted the assault or enjoyed it, and this can lead to increased feelings of shame and guilt (Rumney, 2008). Most research suggests that a cognitive behavioral approach to treatment informed by a knowledge of trauma and attachment theory is the most effective way to treat survivors of sexual assault (Grossman, Sorsoli, & Kia-Keating, 2006: Kia-Keating, Sorsoli, & Grossman, 2009). Research on recovery from traumatic experiences highlights the importance of making meaning out of traumatic events (Grossman, Sorsoli, & Kia-Keating, 2006). In their study, Grossman et al (2006) found that assisting the client in creating a cognitive framework that makes sense of the trauma is a crucial step in recovery. The cognitive framework involves addressing the psychological state of the abuser, and facilitating a greater understanding of the self. In the study, men who had created cognitive explanations for the trauma that shifted the responsibility for the abuse on to the abuser, reported less personal shame and self-blame for the event. For example, one survivor who had undergone extensive cognitive-behavioral therapy for his abuse was able to articulate that his mothers abuse of him was a direct result of her failure to meet her own needs, thus shifting the blame for the abuse on to the abuser and away from the victim (Grossman, Sorsoli & Kia-Keating, 2006). Social workers can assist survivors by helping them to create these cognitive frameworks and by addressing maladaptive beliefs and thoughts related to the traumatic event. Sexual trauma victims often report difficulties in interpersonal relationships. Difficulties with trust, intimacy, emotional discomfort, isolation, and anger are common. Many do not trust

Male Sexual Assault 10 themselves to become involved in a healthy intimate relationship following an instance of sexual assault (Kia-Keating, Sorsoli & Grossman, 2009). Part of the recovery process involves renegotiating meaningful relationships in ones life and rebuilding trust in others and the self. Kia-Keating et al (2009) found that survivors valued safe relationships. The focus of these relationships was nurturance and care giving, especially in the direct aftermath of the event. Others who were not comfortable with physical closeness or care often found solace in the physical comfort provided by a pet (Kia-Keating, Sorsoli & Grossman, 2009). From an attachment perspective, it is easy to understand why survivors of sexual trauma emphasize the importance of trustworthy, caring individuals in their lives. The experience of sexual trauma interferes with the persons beliefs that they can form healthy relationships, and perhaps their ability to do so. Attachment theory posits that maladaptive models of attachment can be corrected with the experience of secure healthy attachment. Therefore, a key task of the social worker treating a survivor of sexual assault is to encourage secure attachment, address issues of trust and intimacy, and use the therapeutic relationship as a model for secure attachment, appropriate boundaries, and healthy relating. Critique As mentioned previously, male sexual assault is a relatively new topic in the clinical literature. Although encouraging strides have been made in addressing mens unique needs when dealing with sexual assault, society has much to accomplish in order to accept males as victims of sexual violence. First and foremost, social workers and other mental health professionals need to advocate on behalf of male survivors in order for them to receive the services they need. From a policy standpoint, changes should be made to laws and policies that do not acknowledge the possibility of male victimization, such as the definition of rape in the FBIs Uniform Crime

Male Sexual Assault 11 Report, so that men are afforded the same protection under the law. Notably, other laws in the United States regarding rape and sexual assault are gender neutral, which indicates some acknowledgment that men are vulnerable to sexual victimization and should be afforded equal protection under the law (Rumney, 2008). Teram et al (2006) point out several areas of focus in which society and professionals can improve in order to best treat this population, addressing the areas of homophobia, lack of concern of abuse of boys by women, addressing mens difficulty expressing their feelings, and directly addressing the gender bias that exists in literature and in practice that seems to suggest that men cannot be victims of sexual violence (Teram, et al, 2006). As a practitioner, being aware of the gender bias in practice with male victims and addressing this in a non-judgmental manner is an important first step. As discussing previously, males who disclose sexual abuse and assault fear judgment and ridicule, especially from professionals (Teram, et al, 2006). Practicing from a gender-sensitive standpoint, the social worker needs to be comfortable with addressing gender stereotypes and acknowledging that male survivors struggle with a unique set of stressors not dealt with by female survivors. In particular, the false belief that victims of male rape are homosexual adds an extra layer of shame and defensiveness to the emotional experience of the male survivor. Clinicians need to be aware of these societal beliefs and stereotypes and be prepared to help male clients discuss their sexual identity, their personal beliefs and values, and their emotions that may change following the traumatic experience of sexual assault. An additional challenge with this population is that as Sorsoli, Kia-Keating, and Grossman (2008) report, many men may lack the emotional vocabulary to discuss their feelings, especially when in reference to traumatic experiences that elicit strong and forbidden emotions.

Male Sexual Assault 12 Clinicians should therefore be prepared to assist men in identifying their emotions by providing them with a safe therapeutic environment and the vocabulary with which to accomplish this. As Rumney, (2008) reports, the criminal justice system still has a long way to go in effectively investigating, reporting, and prosecuting the crime of male rape. Over the past decade, there has been a significant increase in reported male rape, but much still needs to be accomplished. One rape survivor in Rumneys study reported that he was concerned about what a rape charge might mean for his family. Police officers in general report that they are not trained on how to deal with male victims of sexual assault, and men who do go to the police report feeling humiliated and not believed (Rumney, 2008). The role of the social worker with law enforcement is therefore to advocate effectively for clients, to offer services to court proceedings if necessary, to advocate for the clients case, and to educate law enforcement officials and larger communities on the realities of male rape and victimization. Conclusion Although most of the research in this field is exploratory in nature, the current literature suggests a growing awareness of the unique needs of men who have been sexually victimized. Though many reactions to sexual assault seem to be universal to men and women, such as symptoms of PTSD and difficulty with interpersonal relationships, men who are survivors of sexual assault must contend with societal expectations and gender norms that are not consistent with their experience of being victimized. Some research even suggests that men are at a higher risk for developing symptoms of PTSD and related disorders because of the additional pressure placed on them by society to conform to the accepted view of men and masculine traits, including aggression and domination.

Male Sexual Assault 13 Clinicians and policymakers should be aware of these challenges faced by male survivors and should be prepared to address them directly in practice, keeping in mind that the society in which one is raised and in which one lives forms the basis for our beliefs, values, and identities. With increasing awareness in the field, more will soon be known about the unique needs of male sexual assault survivors. As the field progresses, social workers and other mental health professionals should be prepared to educate themselves in order to provide effective, compassionate treatment for these clients.

Male Sexual Assault 14 References

Alaggia, R. & Milligan, G. (2008). Male child sexual abuse: A phenomenology of betrayal. Clinical Social Work Journal, 36. 265-275. American Psychological Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: Washington, DC, Author. Andersen, T.H. (2008). Men dealing with memories of childhood sexual abuse: Conditions and possibilities of positive deviance. Journal of Social Work Practice, 22 (1). 51-65. Denov, M.S. (2004). The long-term effects of child sexual abuse by female perpetrators: A qualitative study of male and female victims. Journal of Interpersonal Violence, 19 (10). 1137-1156. Grossman, F.K., Sorsoli, L. & Kia-Keating, M. (2006). A gale force wind: Meaning making by male survivors of childhood sexual abuse. American Journal of Orthopsychiatry, 76 (4). 434-443. Kia-Keating, M., Grossman, F.K., Sorsoli, L. & Epstein, M. (2005). Containing and resisting masculinity: Narratives of renegotiation among resilient male survivors of childhood sexual abuse. Psychology of Men and Masculinity, 6 (3). 169-185. Kia-Keating, M., Sorsoli, L., & Grossman, F.K. (2009). Relational challenges and recovery processes in male survivors of childhood sexual abuse. Journal of Interpersonal Violence, 20 (10). 1-18. Lemlin, R.H. (2006). Running to stand still: The story of a victim, a survivor, a wounded healerA narrative of male sexual abuse from the inside. Loss and Trauma, 11, 337-350.

Male Sexual Assault 15 Light, D. & Monk-Turner, E. (2009). Circumstances surrounding male sexual assault and rape: Findings from the national violence against women survey. Journal of Interpersonal Violence, 24 (11). 1849-1858. Rumney, P.N.S. (2008). Policing male rape and sexual assault. Journal of Criminal Law, 72. 6786. Sorsoli, L., Kia-Keating, M. & Grossman, F.K. (2008). I keep that hush-hush: Male survivors of sexual abuse and the challenges of disclosure. Journal of Counseling Psychology, 55 (3). 333-345. Teram, E., Stalker, C., Hovey, A., Schachter, C., & Lasiuk, G. (2006). Towards male-centric communication: Sensitizing health professionals to the realities of male childhood sexual abuse survivors. Issues in Mental Health Nursing, 27. 499-517. Tiet, Q.Q., Finney, J.W., & Moos, R.H. (2006). Recent sexual abuse, physical abuse, and suicide attempts among male veterans seeking psychiatric treatment. Psychiatric Services, 57 (1). 107-113. Willis, D.G., (2009). Male-on-male rape of an adult man: A case review and implications for interventions. Journal of the American Psychiatric Nurses Association, 14 (6). 454-461.