A commentary on women in the military who report being raped and being discharged with a personality disorder

Are mental health practitioners using personality disorder diagnoses to help the military “get rid of” women who report being raped? This question is at the heart of a growing concern about the pervasiveness of sexual assault in the military and how the military responds when a sexual assault is reported.

According to the 2011 Annual Report on Sexual Assault issued by Department of Defense, it is estimated approximately 19,000 service members have experienced a sexual assault, yet only about 14% reported it. It’s not surprising that so few victims report. There’s abundant evidence that women in all walks of life – whether in the military or not – are reluctant to report having been raped because they expect they will not be believed, and further, that making their report will have negative consequences for them. The negative consequences will, of course, vary according to the circumstances.

According to some, for women in the military who report being raped, the negative consequences include an increased likelihood of being diagnosed with a personality disorder, followed by discharge from the service.

Support for this proposition is provided by the fact that a substantial number of women in the military describe a similar pattern following their own report of having been sexually assaulted: The person receiving the report, usually the commanding officer, is dismissive of the allegations, and the woman making the report is then diagnosed with a personality disorder and given a psychiatric discharge.

The prospect of being discharged due to a personality disorder would obviously deter many or even most women from making a report. Unlike service members who leave the military with a diagnosis of PTSD, women who are discharged with a personality disorder are ineligible for disability benefits, and may be ineligible for free medical care for their condition. As a result, they may be deprived of needed psychological treatment for the traumatic effects of the assault, unless they can afford to pay for psychotherapy on their own.

Given the serious consequences of a personality disorder discharge, it is important that discharges of this type be reviewed to assure that the diagnosis is fully supported by the facts. If a personality disorder diagnosis was first made following a report of rape, the diagnosis is suspect on its face, thus making a careful and thorough review all the more imperative.

When considering whether a personality disorder is justified, it is important to keep in mind what must be demonstrated. The 4th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (known as the DSM-IV) is the authoritative text for diagnoses of mental disorders. It defines a personality disorder as:

“…an enduring pattern of inner experience and behavior that differs markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Personality disorders are a long-standing and maladaptive pattern of perceiving and responding to other people and to stressful circumstances.”

Unless there is evidence in the records clearly showing a long-standing pattern of pervasive, inflexible and maladaptive behavior prior to the report of sexual assault, a diagnosis of personality disorder would be unreliable.

Military psychologists and psychiatrists who wish to adhere to the standard of care should make a personality disorder diagnosis only if they can demonstrate that the fundamental requirements found in the DSM-IV have been met, as shown by evidence acquired from multiple sources.

It would be disturbing to learn that military psychologists and psychiatrists have made erroneous personality diagnoses because they carelessly ignored or overlooked the requirements stated in the DSM-IV. Their errors would be even more egregious if it is ever discovered that a personality disorder diagnosis was made for the very purpose of ridding the service of women who complain about being sexually assaulted, or about any other form of mistreatment. Actions of this type would be grossly unethical.

The use of personality disorder diagnoses as a way of ridding the service of women who complain about being assaulted would clearly be at odds with our values as a society. The possibility that our military has tolerated or even encouraged such a practice, and that mental health practitioners have been complicit, deserves our urgent attention.

 

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