Body Image Perceptions of Women Veterans With Military Sexual Trauma

Background: The National Accreditation Program for Breast Centers (NAPBC), in a 2014 statement of standards, endorsed breast conservation surgery (BCS) for women with AJCC stage 0,I, or II breast cancer, with a target of 50% BCS. Women comprise the fastest growing segment of Veteran's Health Administration (VA) enrollees, and have high rates of trauma exposure including military sexual trauma (MST). The VA conducts universal screening of all Veterans for MST. Implications for medical care, e.g. an increased rate of hysterectomy among survivors of MST, have been reported. While the numbers of breast cancers treated in VA are relatively small compared to non-VA centers, a trend toward decreasing rates of BCS in VA from 2000-2006 has been reported. Reasons for declining rates of BCS within VA, and the lower rates of BCS in the VA compared to the private sector remain unclear. The objective of this study was to identify determinants of mastectomy versus BCS in women Veterans with early stage breast cancer and to examine whether history of MST was associated with choice of mastectomy versus BCS. Methods: As a quality improvement study, we conducted a retrospective review of all early-stage (0,I,II) female breast cancer patients identified in the tumor registry between 2006-2015 at one Northeastern VA to determine rates of mastectomy and BCS. Through chart review, we examined potential determinants of BCS including age, stage, distance from treating VA facility, genetic testing, contralateral prophylactic mastectomy, and reconstructive surgery. History of MST was documented through chart review. Analyses were performed using unpaired t-test for age and distance from treatment facility and Fisher's exact test for significance comparing history of MST between surgical groups. Results: 70 women with early stage breast cancer were eligible for BCS. Of these, 39 underwent BCS and 31 underwent mastectomy (55% rate of BCS). Age and distance to treating VA were not significant. Women who underwent mastectomy were on average younger (p=0.21) and lived farther away (p =0.42) and were more likely to undergo genetic testing. Of the women who underwent genetic testing (10/70), none had mutations. The biggest difference seen between surgical groups was in history of MST, with women in the mastectomy group having more than twice the prevalence of MST, 58%, vs 31% in the BCS group (p = 0.0154 ). Patient characteristics by type of surgery performed BCS N=39Mastectomy n=31Age (mean)63.559.3Distance from VA56.7 miles67.7 milesGenetic testing (no mutations found)4 (10%)6 (19%)Reconstructive surgery05Prophylactic contralateral mastectomy011MST11(28%)18(58%) Conclusion: These data suggest that MST is associated with choice of mastectomy over BCS. MST results in poor body image which may impact decisions about breast surgery. Trauma-informed strategies for counseling women about options for surgical management of early stage breast cancer may be needed to ensure that women with MST and other forms of trauma pursue evidence-based cancer treatment. Further work with a larger cohort is needed to better understand these findings. Citation Format: Oshry LJ, Naomi K, Megan GR. Military sexual trauma is associated with an increased prevalence of mastectomy versus breast conserving surgery in a population of female veterans with early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-15-01.

Introduction & Purpose Eating disorders, body image, self-esteem, and emotional issues affect psychological and physical health and often co-occur. Disturbances in body image can trigger and worsen disordered eating behaviours. Emotions and self-esteem are influential factors in both eating disorders and body image issues, impacting their severity and manifestation. The interconnection of eating disorders, body image, emotions, and self-esteem has mostly been studied in adolescents, while there has been less research on the adult population. This systematic review seeks to synthesise existing literature on the comorbidity and coexistence of eating disorders, body image disturbance, emotion, and self-esteem in the adult population. Methods Following the PRISMA guidelines, a systematic search was conducted in scientific databases (PubMed, Scopus, and Web of Science) for articles published between 2010 and 2024 (Figure 1). The selected studies focused on the connections between eating disorders, body image, emotion, and self-esteem in adult populations. Six studies were selected from an initial collection of 1,117 articles, with most female participants representing different racial backgrounds. The study participants were required to be over 18 years old and use standard tools to measure the variables, and only original research with significant results was included. Results Individuals with eating disorders showed higher levels of body dissatisfaction, which was linked with lower self-esteem and emotional dysregulation. Women with bulimia nervosa displayed higher emotion-oriented coping strategies compared to controls, resulting in low self-esteem (Wölfges et al., 2011). Obese patients with binge-eating disorders (BED) had more negative attitudes towards obesity compared to obese individuals without BED, correlating with higher levels of depression and disordered eating behaviours (Barnes et al., 2014). The African American participants reported lower weight bias than white participants (Lewer et al., 2015). Furthermore, body image disturbances were a consistent theme, particularly their role in worsening eating disorders, with findings showing that body dissatisfaction indirectly influenced disordered eating behaviours through its effects on self-esteem and depression (Brechan & Kvalem, 2015). The findings revealed that women are more vulnerable to the negative impacts of body image dissatisfaction and emotional dysregulation on eating disorders (Barnes et al., 2014; Brechan & Kvalem, 2015). Additionally, the impact of weight bias and dissociative experiences during sexual activities, which were linked to binge eating and sexual dissatisfaction, was highlighted (Castellini et al., 2017). Discussion The findings emphasise the connections between self-esteem, body image, emotion, and eating disorders. Professional interventions for eating disorders should consider improving self-esteem and providing adaptive emotion techniques to enhance body image perception. The importance of self-compassion in improving body image and managing eating disorders was also noted (Kelly et al., 2014). More research on adult populations in non-Western countries is needed. Conclusion This review emphasises the relationships between eating disorders, body image, self-esteem, and emotion in adults. Moreover, the combination of strategies that improve emotional regulation, self-esteem, and body image perception within clinical interventions could lead to more practical management of eating disorders in adults. Future research should explore these variables across different cultures with varied research strategies.

Although researchers have examined health outcomes among survivors of military sexual trauma, knowledge regarding the phenomenology of military sexual trauma among women veterans remains limited. We used a qualitative, phenomenological approach to describe the experience, context, and perceived effects of military sexual trauma among women veterans. Thirty-two cisgender female military sexual trauma survivors participated in interviews, which we analyzed through thematic analysis. The following themes emerged: (1) sexual harassment: “expected,” “constant,” and “normal”; (2) silencing and disempowerment: “If you want a career, then shut up”; (3) changed attitudes toward the military: “I lost faith”; (4) loss of relational trust: “I can protect me if I’m not involved with someone”; (5) survivor internalization of messages conveyed by military sexual trauma: “If I looked different, none of this would have happened”; (6) coping by escape and avoidance: “I put my head in the sand and hoped it would go away”; and (7) a path to healing through validation and justice: “You’ll get through it.” Results suggest the importance of increasing stakeholders’ knowledge regarding military sexual trauma complexities and contexts. Military sexual trauma survivors should be heard, believed, and supported in pursuing justice. We also suggest cultural shifts and continued efforts to prevent military sexual trauma. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

ABSTRACTBACKGROUNDMilitary sexual trauma (MST) is the Veteran Health Administration’s (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans.OBJECTIVETo estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men.DESIGN AND PARTICIPANTSNational, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010.MAIN MEASURESAll variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization.KEY RESULTSOf homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST.CONCLUSIONSA substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless programs in providing mental health care to homeless Veterans.

Anxiety sensitivity (AS), the degree to which individuals fear bodily sensations associated with anxious arousal, has been implicated in the development and maintenance of posttraumatic stress disorder (PTSD). Despite this well-established link, AS has yet to be examined among women who experience military sexual trauma (MST). This is particularly important as research has shown that rates of AS and PTSD are higher among females compared to males. Thus, the purpose of the current investigation was to examine the association between AS and overall PTSD symptom and cluster severity using a sample of female Veterans with a history of MST. The sample included 50 women Veterans presenting for psychological services to a MST specialty clinic at a large southeastern Veterans Affairs hospital. Results revealed a significant positive association between AS and overall PTSD symptom severity, even after controlling for levels of depression, which appeared to be driven by the relationship between AS and negative alterations in cognitions and mood and arousal and reactivity clusters. These findings provide initial support for the association between AS and PTSD symptoms among female Veterans with a history of MST. Given the malleable nature of AS, future research should examine the extent to which targeting this cognitive-behavioral construct reduces PTSD symptoms among such samples.

Objective: Sexual violence predicts both posttraumatic stress disorder (PTSD) and distress during gynecological health care. Yet sexual trauma represents only one event that can precipitate posttraumatic distress, and less is known about PTSD and gynecological-related factors in survivors of nonsexual trauma. We examined PTSD symptomatology and gynecological-related factors in 1,185 women veterans with diverse trauma histories. Methods: This cross-sectional analysis leveraged data from a national survey. Women self-reported their lifetime history of sexual violence (any versus none); military sexual trauma (MST) exposure (no MST, harassment only, assault); PTSD symptoms; distress experienced during gynecological care; and gynecological health care-seeking. Analyses assessed whether associations between PTSD symptomatology and gynecological-related factors depended on lifetime or military-specific sexual trauma. Exploratory analyses considered whether certain PTSD symptom clusters (Criterions B-D: re-experiencing, avoidance, negative cognitions/mood, hyperarousal) particularly contributed to distress. Results: Greater PTSD symptoms were linked with greater emotional distress, physical discomfort, and fear during gynecological exams; these associations did not depend on lifetime sexual violence, though there was some variation by MST type. Greater Criterion D and E symptomatology uniquely accounted for distress across most indicators. Analyses considering health care-seeking largely yielded null findings. Conclusion: Posttraumatic psychopathology is relevant to gynecological-related distress in trauma-exposed women veterans, regardless of lifetime sexual trauma, and certain symptoms-including negative thoughts/feelings and hyperarousal-may be especially pertinent. Further, MST may compound the effects of PTSD on gynecological care experiences. Findings support assessing gynecological-related distress in all trauma-exposed women exhibiting PTSD symptoms and emphasize the need for trauma-informed reproductive health care.

Military sexual trauma (MST) is associated with high rates of post-traumatic stress disorder (PTSD) and multiple comorbid symptoms. In addition, women Veterans with MST report negative perceptions of social support, poor relationships, and difficulties in social and role functioning. Treatments for PTSD do not provide interventions to improve social or relationship functioning and do not consistently produce positive benefits regarding these outcomes. This article presents a series of case studies in which an intervention focused on building social support and relationship skills is delivered to Veterans with PTSD and MST. The intervention, Skills Training in Affective and Interpersonal Regulation (STAIR) promotes social engagement and skills that support greater role functioning. It can be used as a stand-alone treatment, as an adjunctive intervention to PTSD therapies or as part of a combination therapy in which skills precede trauma-focused work (STAIR Narrative Therapy). Further investigation is suggested to determine the added benefits of incorporating skills building to PTSD or other diagnosis-specific interventions.

This qualitative study provides a platform for women veterans to inform our perspective of their experienced impacts following military sexual trauma (MST). We engaged 23 women veterans in semistructured interviews and used a grounded theory-informed thematic analytic approach, to interpret women's experiences. Women described negative impacts of their MST experiences across psychological, behavioral, and occupational domains. Less frequently, women discussed experiences of posttraumatic growth. These results aid our understanding of the complexities of women's posttrauma experiences and suggest that holistic intervention frameworks focused on a range of potential intervention targets are warranted in helping women veterans recover from MST.

Through the lens of Social Comparison Theory, this thesis' research investigates the influences that the social media platform TikTok has on the body image perception and mental health of adolescent girls, aged 15-17 years. Given the rapid growth in usage of social media platforms, such as TikTok, understanding their impact on self-perception is crucial for addressing and evaluating mental health challenges among young individuals. These girls are part of the next generation, and we need to protect them from the harsh, unrealistic, and demoralizing standards often displayed on social media. Through in-depth interviews, participants shared how TikTok content, particularly videos focused on weight loss, dieting, and idealized beauty standards shape young girls' body image. Findings reveal that engagement with TikTok often leads to negative emotions such as insecurity, anxiety, and self-doubt, mainly due to the pressure to conform to unrealistic standards set by influencers. The study also highlights the role of social validation in relation to likes and comments. The study uncovers how compulsive scrolling, and the Fear of Missing Out (FOMO) exacerbate feelings of inadequacy, leading to unhealthy cycles of comparison and emotional distress. This research underscores the complex relationship between social media, body image, and mental health. Ultimately, the findings suggest that while TikTok can offer supportive spaces, its dominant content reinforces harmful comparison dynamics, which can negatively affect self-esteem and well-being in young girls.

The experience of breast cancer and related treatments has notable effects on women's mental health. Among them, the subjective perception of the body or body image (BI) is altered. Such alterations deserve to be properly treated because they augment the risk for depression and mood disorders, and impair intimate relationships. A number of studies revealed that focused psychological interventions are effective in reducing BI issues related to breast cancer. However, findings are inconsistent regarding the dimension of such effects. This meta-analysis synthesizes and quantifies the efficacy of psychological interventions for BI in breast cancer patients and survivors. Additionally, since sexual functioning emerged as a relevant aspect in the BI distortions, we explored the efficacy of psychological interventions on sexual functioning related to BI in breast cancer patients and survivors. The literature search for relevant contributions was carried out in March 2020 through the following electronic databases: Scopus, PsycINFO, and ProQUEST. Only articles available in English and that featured psychological interventions for body image in breast cancer patients or survivors with controls were included. Seven articles with 17 dependent effect sizes were selected for this meta-analysis. Variables were grouped into: Body Image (six studies, nine dependent effect sizes) and Sexual Functioning Related to the Body Image in breast cancer patients and survivors (four studies, eight dependent effect sizes). The three-level meta-analysis showed a statistically significant effect for Body Image [g = 0.50; 95% CI (0.08; 0.93); p < 0.05] but no significant results for Sexual Functioning Related to Body Image [g = 0.33; 95% CI (−0.20; 0.85); p = 0.19]. These results suggest that psychological interventions are effective in reducing body image issues but not in reducing sexual functioning issues related to body image in breast cancer patients and survivors. Future review efforts may include gray literature and qualitative studies to better understand body image and sexual functioning issues in breast cancer patients. Also, high-quality studies are needed to inform future meta-analyses.

Research ObjectiveResearch suggests that about 80% of women veterans receiving care at the Department of Veterans Affairs (VA) have experienced at least one trauma in their lifetimes, including military sexual trauma or combat‐related trauma. Trauma‐sensitive communication reflects an understanding of the impact of trauma and the needs of trauma survivors during health care encounters. We explored whether provider gender sensitivity is associated with positive ratings of trauma‐sensitive communication among women veteran patients.Study DesignWe conducted cross‐sectional surveys of providers to measure provider gender sensitivity using 10 survey items adapted from the Gender Awareness Inventory‐VA. Example items included “Sometimes I wish VA primary care clinics had only male patients.” We averaged responses in 5‐point Likert scales to create a composite score, with a higher score indicating higher sensitivity. We used cross‐sectional surveys of patients to measure women veterans' perspectives of trauma‐sensitive communication: providers (1) asked about any serious problems or stresses in life (yes vs no), (2) made sure they were comfortable before any treatments or examinations (always vs otherwise), and (3) made them feel comfortable talking about emotional issues (very comfortable vs otherwise). We linked survey responses of providers to women veterans via VA primary care visit information in 2014. We used logistic regression to predict each measure of trauma‐sensitive communication, controlling for women veterans' age, race, and ethnicity, a service‐connected disability, military sexual trauma, physical and mental comorbidities, and primary care and mental health visits in 2014. All analyses were weighted for survey nonresponses.Population StudiedA total of 94 primary care providers (PCPs) (33% response rate) and 1395 women veterans (45% response rate) from 12 VA medical centers (VAMCs) completed the surveys between 2014 and 2015. After linking women veterans to PCPs, they had visited for primary care or women's health at the same 12 VAMCs in 2014, and the analyses included 804 women veterans and 58 PCPs who responded to the surveys.Principal FindingsOverall, 80.3% of women veterans reported that their PCPs asked about any serious problems or stresses in life, 79.3% reported that PCPs always made sure they were comfortable before any treatments or examinations, and 55.6% felt very comfortable talking with PCPs about emotional issues. After adjusting for covariates, higher provider gender sensitivity score was associated with more women veterans reporting that (1) PCPs asked about any serious problems or stresses in life (AOR: 1.33, 95% CI: 1.08‐1.63), (2) PCPs always made sure they were comfortable before any treatments or examinations (AOR: 1.10, 95% CI: 0.91‐1.34), and (3) they felt very comfortable talking with PCPs about emotional issues (AOR: 1.11, 95% CI: 0.93‐1.30).ConclusionsOverall, women veterans' ratings of trauma‐sensitive communication were positive. Higher provider sensitivity was associated with greater trauma‐sensitive communication.Implications for Policy or PracticeStrategies to improve provider readiness to care for women veterans and their gender sensitivity can improve trauma‐sensitive communication with women veterans.Primary Funding SourceDepartment of Veterans Affairs.

A review of the literature on racial differences in body image in Black and White women indicates body image dissatisfaction is more common in White females than Black females. However, Black women are not protected from body image issues. Research on body image concerns specifically related to Black women is limited. The present study involves focus group and individual interviews conducted with 16 Black women. Data were analyzed using qualitative methodology. Results indicate 6 major themes, with shapely and curvaceous ideal body image standards within the Black community as the most prevalent theme across data sources. Therapeutic implications emphasize recognition of culture-specific ideal standards of beauty, as well as the influence of external factors such as men, family, peers, and media on Black women's self-evaluations.

Purpose: This study sought to determine whether healthy, overweight, and obese preadolescents living in low-income neighborhoods differ in regards to body image and weight control behaviors. It is critical to identify early precursors to body image issues so that optimal prevention programs can be implemented. Subjects: The sample consisted of 64 preadolescents ages 8 to13 years, including 29 male (45%) and 35 female (55%) fourth, fifth, and sixth graders living in low-income neighborhoods in Fresno, California. Measures: (a) Height and weight were measured to calculate BMI-for-age (kg/m2 ), and (b) the CDC 13- question Body Image Survey was administered. Analysis: ANOVA was used to compare differences in body image and weight control behaviors by weight category (healthy, overweight, obese).Results: The obese group reported more body image dissatisfaction than did the healthy and overweight groups. Obese preadolescents were less happy with their body image and dieted more than healthy weight preadolescents. Overweight preadolescents were more similar in behaviors to healthy weight preadolescents than obese preadolescents. Conclusions: Low self-esteem related to weight may be exacerbated in the adolescent years when new pressures and challenges emerge. Targeting preadolescent overweight and obese individuals with body image issues may be useful in ameliorating some of the problems that are magnified in adolescence, such as dieting and eating disorders.

AimThis study aimed to assess weight control behaviors and their relationship with body weight and image perceptions among female university students.Subject and methodsA cross-sectional study was conducted among female students. The study included 420 female students aged 17–27 years using a convenient sample. Students were invited from all faculties. The data collection tools included a questionnaire, body image perceptions scale, and measurement scale for weight and height.ResultsOf the participants, 154 (36.9%) female students (95% CI 32–41%) had risky eating behaviors and reported a significant level of concern about diet and weight. In general, most of the study sample were dissatisfied with their bodies; in particular, 55.7% of participants were suffering from negative body image, while 24.5% showed a positive body image. Approximately one-third (31.8%) of underweight university students participated in risky eating behavior compared to 36.3% and 44.4% in normal weight and overweight and obese groups, respectively. The logistic regression analysis revealed that weight control behaviors were mainly associated with the perception of body image.ConclusionThe results showed a high level of concern about food and weight by the female students. Additionally, it showed that they are prone to risky eating behaviors. Therefore, interventions are needed to promote healthy eating behaviors and body image among university students.

This study sought to understand the experience of women veterans transitioning from military to civilian life. A community-based research design and Ricoeur's hermeneutic phenomenology guided the philosophical framework. Seventeen women veterans were recruited from a non-profit organisation. Data was collected in six virtual focus groups using Zoom in the fall of 2022 using dialogical engagement. Analysis of the data was done using hermeneutic phenomenology. Five participants in the research validated the data and recommended changes to their peer-to-peer support group. The veterans described their environment as service to confusion and from pride to embodied shame. The phenomenology of this experience was screaming in silence, harsh reality, creating a village, and taking the high road. Lists of deployment and military sexual trauma triggers were created. There are many obstacles for women transitioning from military to civilian life. Some veterans suffer more than others. For those who are challenged by living in civilian life, this study strongly emphasised that veterans are often their own best source of support. Peer-to-peer support groups for women veterans were highly encouraged as a vital part of their well-being. The data obtained in this study provided us with rich information for nursing practice, including an understanding of the way of being of women veterans, suicide, military sexual trauma, and homelessness assessment, significant community resources, the significance of having peer-to-peer support groups, and the policies and research needed. Consolidated criteria for reporting qualitative research. This study did not include patient or public involvement in its design, conduct, or reporting.