Sexual harassment and assault as predictors of PTSD symptomatology among U.S female Persian Gulf War military personnel. (posttraumatic stress disorder)

An increasing body of empirical literature documents high rates of sexual assault and related sexual aggression against women in this country. Lifetime rates of completed rape among females have been reported to be as high as 13% (National Victims Center [NVC], 1992). Less severe forms of victimization (e.g., verbal and physical sexual harassment), which are often overlooked, are even more prevalent than assault and may be quite common (Martindale, 1990). A recent large-scale survey of federal employees, for example, found that 44% of women and 19% of men experienced some form of uninvited or unwelcome sexual attention in the workplace over a 2-year period (U.S. Merit Systems Protection Board [USMSPB], 1995).

Sexual victimization of women has been conceptualized along a continuum, ranging from most (sexual assault) to least (verbal harassment) severe (Lott, 1995). More severe experiences have been linked to high rates of psychological disturbance, including posttraumatic stress disorder (PTSD) and major depression (NVC, 1992). PTSD in particular may be an especially common outcome. One study showed that completed rape led to PTSD in as many as 90% of women at 4 weeks postassault and remained as high as 47% at 3 months postassault (Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992). Although community samples report significantly lower rates of lifetime and current PTSD following sexual assault, these rates (along with those for physical assault) exceed those reported following other major stressors (Norris, 1992; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). Female sexual assault survivors are also at an increased risk for developing other noteworthy difficulties, including self-blame, anxiety, phobia, substance abuse, suicidality, and substantially increased health care use (Resick, Calhoun, Atkeson, & Ellis, 1981; Roth & Lebowitz, 1988). Furthermore, sexual assault has been preliminarily linked to a greater risk for subsequent revictimization, suggesting a cumulative effect (Wyatt, Guthrie, & Notgrass, 1992).

Although less is known about the effects of less severe forms of sexual harassment (i.e., physical and verbal sexual harassment), initial research suggests that these experiences also have a substantial impact. In addition to depression and anxiety, other effects include job attrition (Gutek, 1985), academic decline (Fitzgerald et al., 1988), disturbed interpersonal relationships, and increased health complaints (Crull, 1982). Data from other trauma populations indicate that certain factors (e.g., social support, coping style) can mitigate the effects of trauma (Resnick, Kilpatrick, Best, & Kramer, 1992). Consequently, if events involving sexual aggression are viewed on a spectrum similar to other trauma experiences, it is possible that sexual harassment may affect some women differently than others.

Until recently, sexual victimization in military work settings received little attention (Engel et al., 1993; Martindale, 1990; Wolfe, 1990). However, the growing number of women in military service (Dienstfrey, 1988) and the much publicized Tailhook incident in 1991 have drawn widespread attention to the problem of sexual harassment and assault of women in the U.S. armed forces. To date, a paucity of empirical data has documented the prevalence or sequelae of these events. Martindale (1990) reported that 5% of female respondents described attempted or completed sexual assault during military service over an 18-month period. Rates of sexual harassment were considerably higher, with 15% reporting pressure for sexual favors and 38% describing unwanted physical contact (e.g., touching). This survey provided important information about sexual victimization during peacetime service but did not address the prevalence or sequelae of these experiences during wartime deployment. Still unknown is how effects of sexual trauma compare to those of nonsexual stressors, for example, exposure to combat stress. Combat has been robustly associated with PTSD in male and, to a lesser degree, female military personnel (Kulka et al., 1988). The persistence of this disorder is attested to by the fact that, 20 years after the conclusion of the Vietnam War, 15.2% of male theater veterans still manifest significant symptoms of PTSD. With the increasing rate of women in the U.S. military, the evaluation of female soldiers' experiences offer an important opportunity to assess rates and effects of a range of traumatic stressors.

To our knowledge, an empirical study of PTSD symptomatology across recent sexual assault and combat experiences within a single sample has not yet been conducted. Given high rates of the former among women, more research is needed to assess the occurrence of and relationship between high-magnitude stressors such as sexual assault and combat stress. In addition, more exploration of the psychological impact of less severe forms of sexual harassment is warranted. To accomplish these tasks, we surveyed a sample of female American army veterans who were deployed during the Persian Gulf War and were exposed to a range of potentially life-threatening war zone activities. Our goal was threefold: (a) to determine the rates of sexual victimization experiences in women during military deployment, (b) to examine relationships between harassment severity and variables that may moderate their effects, and (c) to assess the effects of harassment events on psychological status, specifically PTSD symptomatology. All participants were members of the Ft. Devens Operation Desert Storm (ODS) Reunion Survey, an ongoing longitudinal project involving army personnel who were deployed to the Persian Gulf from New England in 1991 (Wolfe, Brown, & Kelley, 1993). For this study, we collected data for two time periods: during deployment in the Persian Gulf and during the 18 to 24 months following the soldiers' return. We assessed deployment period combat exposure, experiences of sexual harassment and sexual assault, coping, unit cohesion, and leadership support. Postdeployment measures included the assessment of social support and trauma during the 18 to 24 months since …