By Virginia M. DeRoma, Ph.D., ABPP, U.S. Navy Lt. Cmdr. Trinity Dunham, Psy.D., ABPP, Sharmila Chari, Ph.D.
Feb. 29, 2024

U.S. Navy photo by Mass Communication Specialist 2nd Class Jasmine Ikusebiala

The higher prevalence of interpersonal violence found in military settings has prompted initiatives to address large scale change to reduce violence. To date, we have learned a great deal about military-specific risk factors and associated patterns of suppression in acknowledging, reporting, and healing from IPV.^1,2,3 The importance of prioritizing approaches to address IPV is underscored by the association noted between IPV exposure and several negative psychological health outcomes, including alcohol misuse, depression, posttraumatic stress disorder, and suicidal ideation.^4,5,6

Beyond direct help provided to perpetrators and survivors, advancements in policy and research priorities have contributed to movement toward desired prevention outcomes. While it’s easy to focus on day-to-day, direct care roles to make a difference, recognition of institutional progress can empower collaborative efforts in building larger comprehensive and practical solutions.

A comprehensive understanding of the levels of influence and factors at play in IPV dynamics is needed to build impactful policies and programs. The social-ecological model provides a useful framework for examining IPV, as it includes a focus on individual, family, workplace, and community.⁷ At the individual level, risk factors for victims and perpetrators alike are important to include in the design of comprehensive approaches to reduce the occurrence and impact of IPV.⁸ Recommendations for the inclusion of trauma and substance misuse components in perpetrator programs represent efforts at this level.⁹ At the family-level, comprehensive approaches have undertaken the examination of important familial issues such as intimate partner violence and child maltreatment with attention to the nature of perpetration at multiple levels, including physical, psychological, and emotional.¹⁰  A focus on IPV in the workplace environment has provided unique opportunities to examine the interplay of cultural (e.g., military system experiences and values) and subcultural (e.g., conformity)¹¹ influences on how IPV manifests and who it affects.¹²

Practitioners may feel removed from the rollout of institutional agendas, policies, and guidelines aimed at reducing IPV. These efforts might not seem to impact daily practices, but they do make important connections to front-line clinical work. A few examples of progress relevant to clinical work include:

• VA/DOD Clinical Practice Guidelines: CPGs are a great example of an institutional partnership that helps providers by publishing current, scientifically-supported recommendations for patient care. In fact, CPGs for depression, PTSD, and substance use may be useful for mental health conditions associated with IPV.¹³
• The Independent Review Commission on Sexual Assault in the Military (2021): The commission supported the creation of workgroups to address recommendations in four key areas: accountability, prevention, climate and culture, and victim care and support. The report called for the creation of a “state-of-the-art” prevention research capabilities in DOD and identified several themes being addressed in current research.

Policy-directed Support

• The recently published DOD Instruction 6400.11, “DOD Integrated Primary Prevention (IPP) Policy for Prevention Workforce and Leaders,” asks for leadership to cultivate inclusivity, connectedness, dignity, and respect in the military community. Additionally, leaders are expected to understand trauma, reduce stigma around reaching out for help, and actively support referrals.   
• DOD Instruction 1020.03, “Harassment Prevention and Response in the Armed Forces,” provides information on efforts to improve prevention and responses, including: defining harassment and sexual assault, prevention program requirements, reporting options and procedures, and how to respond to reported incidence.

Collectively, these standards could go a long way towards creating greater safety in seeking and receiving the right help.

Research

The Integrated Prevention Research Agenda has three focus areas targeting interpersonal (and self-directed) harm for FY2024, including: defining risk and protective factors at individual and organizational levels, targeting of subpopulations, and improved data collection and dissemination on hazing and bullying. DOD’s Sexual Assault Prevention and Response Research Agenda FY2021-2025, has also given important direction to understudied topics. It raises hopes for results that can make their way to practice. Current endeavors addressing aspects of either or both agendas include:

• Sexual violence perpetrated against males, who are less often researched (and for whom many have a hard time taking seriously as survivors) is currently being undertaken by several researchers.^14,15 Given military-specific barriers related to stigma, underreporting, and reluctance to seek help, this work may feed an improved awareness and understanding of male survivor assault dynamics.
• Underlying drivers of intimate partner violence, another understudied research topic, is being addressed by current projects: 1) The Navy’s Getting Better Together¹⁶ relationship education curriculum teaches couples to work as a team to better regulate emotions and cope with stress, and 2) Strength at Home Couples Program¹⁷ uses a social information-processing model that is sensitive to prior experiences and trauma to address relationship distress.
• The Psychological Health Center for Excellence offers expertise in research and analytics that help make research applicable and digestible to clinicians, including 1) Psych Health Evidence Briefs and systematic reviews summarize and synthesize current research data and 2) the Practice-Based Implementation Network, a DOD/Veterans Affairs partnership, whose pilots improve clinical care by translating policy and promising research findings into adoption.

The focus on helping is apparent in resources for service and family members so they can strengthen healthy behaviors and have information readily available when needed. Prevention is better than cure. Seeking help early, before an incident occurs, is vital for a strong and healthy family. Read below for information about such resources:

• U.S. Marine Corps offers monthly newsletters on specific prevention topics and is published as online to support healthy skills and behaviors. 
• The Real Warriors Campaign provides mental health education to support the courage to seek assistance, reinforcing that reaching out for help is a sign of strength. Highlights include:
  • Articles, like “Understanding and Managing Reactions from Experiences of Sexual Assault” provide information on common reactions that are signs of needing help, as well as sources of support available for survivors.
  • A video spotlight on a sexual assault survivor, highlights how reaching out to others, although hard, so often helps. 
• The Sexual Assault Prevention and Response Office, Victim Assistance offers education on the Survivors’ Bill of Rights, as well as assistance and reporting options, legal counsel, and campaign support for assault experienced by male service members. 
• DOD Safe Helpline provides 24/7 confidential phone (Call 877-995-5247), chatroom, and online resources available to service and family members and is operated by the Rape, Abuse, & Incest National Network on behalf of SAPRO.
• Military OneSource provides 24/7 support through confidential military and family life counseling and support in areas like new parenting and transitions stress, domestic abuse victim advocacy, and general promotion of healthy relationships.   

In addition to promoting these resources, providers are encouraged to make therapy referrals to behavioral health providers for those who identify as a survivor of sexual harassment or assault and need help. Reductions in IPV in the military rely on connections between research, policy, practice, referral and resource/education advancements, and dissemination. While only a sample of those resources were highlighted here, taken together they represent the synchronization moving us forward, together. Ultimately, our commitment to the connection is what makes a difference in the voices of the service members being lifted and heard.

References

1. Bourgeois, M. L., & Marx, B. P. (2019). Military sexual assault. In W. T. O’Donohue & P. A. Schewe (Eds.), Handbook of sexual assault and sexual assault prevention. (pp. 709–720). Springer Nature Switzerland AG. https://doi.org/10.1007/978-3-030-23645-8_42
2. Lucas, C. L., Schuyler, A. C., Kintzle, S., Wails, K. M., Nordwall, H. I., & Castro, C. A. (2022). Military sexual assault. In C. H. Kennedy & E. A. Zillmer (Eds.), Military psychology: Clinical and operational applications., 3rd ed. (pp. 205–220). The Guilford Press.
3. Park, Y., Sullivan, K., Riviere, L. A., Merrill, J. C., & Clarke-Walper, K. (2022). Intimate partner violence perpetration among military spouses. Journal of Interpersonal Violence, 37, 15-16, NP13497–NP13517. https://doi.org/10.1177/08862605211004139
4. Sparrow, K., Kwan, J., Howard, L., Fear, N., & MacManus, D. (2017). Systematic review of mental health disorders and intimate partner violence victimisation among military populations. Social Psychiatry and Psychiatric Epidemiology, 52, 1059–1080. https://doi.org/10.1007/s00127-017-1423-8
5. Fedina, L., Nam, B., Jun, H.-J., Shah, R., Von Mach, T., Bright, C. L., & DeVylder, J. (2021). Moderating effects of resilience on depression, psychological distress, and suicidal ideation associated with interpersonal violence. Journal of Interpersonal Violence, 36(3-4), NP1335-1358NP. https://doi.org/10.1177/08862605177461836.
6. Fernández-Fillol, C., Pitsiakou, C., Perez-Garcia, M., Teva, I., & Hidalgo-Ruzzante N. (2021). Complex PTSD in survivors of intimate partner violence: Risk factors related to symptoms and diagnoses. European Journal of Psychotraumatology, 12(1), 2003616. https://doi: 10.1080/20008198.2021.2003616
7. Wojda, A, Heyman, R., Slep, A., Foran, H., Snarr, J., & Oliver, M. (2017) Family violence, suicidality, and substance abuse in active duty military families:  An ecological perspective. Military Behavioral Health, 5(4), 300-312, https://doi: 10.1080/21635781.2017.1343698
8. Spenser, C., Stith, S., & Cafferky, B. (2019). Risk markers for physical intimate partner violence victimization:  A meta-analysis. Aggression and Violent Behavior, 44, 8-17.
9. Karakurt, G., Koc, E., Cetinsaya, E., Ayluctarhan, Z., & Bolen, S.  (2019). Meta-analysis and systematic review for the treatment of perpetrators of intimate partner violence.  Neuroscience and Behavioral Reviews, 105, 220-230.
10. Kwan J, Sparrow K, Facer-Irwin E, Thandi G, Fear NT, & MacManus D. (2020). Prevalence of intimate partner violence perpetration among military populations: A systematic review and meta-analysis. Aggression and Violent Behavior,53, 101419. https://doi: 10.1016/j.avb.2020.101419.  
11. Karakurt, G., Koc, E., Cetinsaya, E., Ayluctarhan, Z., & Bolen, S.  (2019). Meta-analysis and systematic review for the treatment of perpetrators of intimate partner violence.  Neuroscience and Behavioral Reviews, 105, 220-230.
12. Stuart, J. & Szeszeran, N. (2021) Bullying in the military: A review of the research on predictors and outcomes of bullying and bullying victimization and perpetration. Military Behavioral Health, 9(3), 255-266, https://doi: 10.1080/21635781.2020.1864527
13. Patel, T.A., Mann, A.J., Nomamiukor, F. O., Blakey, S. M., Calhoun, P.S., Beckham, J. C. Pugh, M. J., & Kimbrel, N. A. (2022). Correlates and clinical associations of military sexual assault in gulf war era US Veterans:  Findings from a national sample. Journal of Traumatic Stress, 35(4), 1240-1251. https://doi.org/10.1002/jts.22825
14. Berry-Caban, C. S., Allan, E., Orchowski, L., & Elwy, R. (2022, May). StopHazing: Preventing sexual violence toward male victims through targeting hazing behavior [Presentation]. In Progress Review Meeting, Washington, D.C.
15. Scaglione, N., Kan, M., & Robinson, K. (2022). Reducing sexual assault at the U.S. Air Force Academy: Adaptation, implementation, and evaluation of the Sexual Communication and Consent Form [Presentation]. In Progress Review Meeting, Washington, D.C.
16. Carter, S., Cobb, E., LaCroix, J., Holloway, M., & Lee-Tauler, S. Y. (2022, May). Better Together: A primary prevention intervention targeting transdiagnostic interpersonal emotion regulation among military couples [Presentation]. In Progress Review Meeting, Washington, D.C.
17. Rothman, E. & Taft, C. (2022). Strength at Home Couples Program:Examining sexual aggression [Presentation]. In Progress Review Meeting, Washington, D.C.

Virginia DeRoma, Ph.D., ABPP, is a clinical psychologist and contracted subject matter expert with expertise in trauma. Dr. DeRoma works as a senior technical advisor to the Defense Health Agency Psychological Health of Center Excellence. She has supported PHCoE’s Research Portfolio Management and Practice-based Implementation Network divisions.

U.S. Navy Lt. Cmdr. Trinity Dunham, PsyD, ABPP is a Navy psychologist currently assigned to Naval Hospital Bremerton, where she serves as the Mental Health Department Division Officer and staff psychologist.  She was previously assigned to PHCoE and specializes in clinical and military psychology.

Sharmila Chari, Ph.D., is a clinical psychologist by training. She is currently serving as a contracted senior scientific advisor in the Research Execution section at the Psychological Health Center of Excellence. She has experience in psychological health research portfolio management, program development, conducting research and evaluation for serious mental illnesses and substance use disorders, equitable mental healthcare delivery, and trauma-informed programs.