Podcast: Male Survivors of Sexual Assault and Abuse

Did you know one in six males are sexually assaulted before their 18th birthday? Unfortunately, many victims are reluctant to come forward due to cultural conditioning. In today’s podcast, Gabe speaks with two psychologists about this very common but somewhat taboo issue. They tackle the prevalent myths surrounding male sexual assault and discuss why so many victims suffer in secrecy.

What can be done? Where can survivors reach out for help? Join us for an in-depth talk on this very important and under-discussed topic.

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Guest information for ‘Male Sexual Assault’ Podcast Episode

Dr. Joan Cook is a clinical psychologist and Associate Professor in the Yale School of Medicine, Department of Psychiatry. She has over 150 scientific publications in the areas of traumatic stress, geriatric mental health and implementation science fields. Dr. Cook has worked clinically with a range of trauma survivors, including combat veterans and former prisoners of war, men and women who have been physically and sexually assaulted in childhood and adulthood, and survivors of the 2001 terrorist attack on the former World Trade Center.  She has served as the principal investigator on seven federally-funded grants, was a member of the American Psychological Association (APA) Guideline Development Panel for the Treatment of PTSD and the 2016 President of APA’s Division of Trauma Psychology. Since October 2015, she has published over 80 op-eds in places like CNN, TIME Ideas, The Washington Post and The Hill.

Dr. Amy Ellis is a licensed clinical psychologist and the Assistant Director of the Trauma Resolution and Integration Program (TRIP) at Nova Southeastern University. TRIP is a university-based community mental health center that provides specialized psychological services to individuals age 18 and above who have been exposed to a traumatic situation and are currently experiencing problems in functioning as a result of the traumatic experience. Dr. Ellis has also developed specific clinical programming focusing on trauma-informed affirmative care for sexual and gender minorities as well as gender-based services focusing on male-identifying individuals at TRIP. Dr. Ellis is involved in a variety of leadership activities within the American Psychological Association (APA), including service as a Consulting Editor for three peer-reviewed journals, Guest Editor for Practice Innovations on a special issue dedicated to the role of evidence-based relationship variables in working with sexual and gender minorities, and she is also the Editor for APA’s Division 29 (Psychotherapy) website.  

About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Male Sexual Assault’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast. Calling into the show today, we have Dr. Amy Ellis and Dr. Joan Cook. Amy is a licensed clinical psychologist and the assistant director of the Trauma Resolution and Integration Program at Nova Southeastern University, and Joan is a clinical psychologist and associate professor in the Yale School of Medicine, Department of Psychiatry. Amy and Joan, welcome to the show.

Dr. Joan Cook: Thank you. Happy to be here.

Dr. Amy Ellis: Thank you.

Gabe Howard: Well, I am very glad to have both of you, because we have a really big topic today, we’re going to be discussing male survivors of sexual abuse and assault. And I’m a little bit embarrassed to admit when we first started putting together this episode, I thought to myself, is this a subject that we need to cover? Is it big enough? Aren’t we already discussing it? And the research that I did and the stuff that I learned from both of you, so thank you very much, is that it’s actually sort of under-discussed and underreported.

Dr. Joan Cook: Absolutely. And thank you, Gabe, for admitting to that. I think a lot of health care providers, a lot of the public and many male survivors themselves adhere to a number of male rape myths. We need to talk in this country about how rape and sexual assault of boys and men not only as possible, but actually occurs at high rates. If I could share with you just a snippet of how frequently it occurs.

Gabe Howard: Yeah, please, please. That is my next question. What are the prevalence rates?

Dr. Joan Cook: Ok. So I think a lot of people don’t know this, but at least one in six boys are sexually abused before their 18th birthday. One in six. And this number rises to one in four men who are sexually abused across their lifespan. That’s too many.

Gabe Howard: Obviously, any number is too many.

Dr. Joan Cook: Absolutely.

Gabe Howard: But that stat blew me away. At the start of my research for this episode, I believed that the number was half a percent, like it was just ridiculously low.

Dr. Joan Cook: Right? And I think that’s because, let’s face it, people don’t report sexual assault. Both men and women don’t tend to report it to law enforcement agencies or to the FBI. We just don’t have good crime statistics on these. Why? Shame, embarrassment, minimization, and people not believing survivors. You know, a lot of the research and the clinical scholarship that we have on sexual abuse, including the development and testing of psychosocial interventions, really focuses on women. And that’s important for sure. Absolutely. But men and boys who experience sexual abuse, they’re out there and they’re largely overlooked. They’re stigmatized or shamed by the public and sometimes by health care professionals. It’s just not acceptable.

Gabe Howard: I also noticed that pop culture covers everything. But this is not a trope in pop culture. We see the sexual assault of women in Law & Order SVU in primetime television week after week and marathons all weekend. But I can’t really think of any pop culture representation of sexual assault, rape, or trauma in pop culture at all. Outside of that one movie from the 70s with the banjo and that’s largely regarded as like a horror movie. And do you think that this plays into the public dismissing sexual assault on men and boys?

Dr. Amy Ellis: Absolutely. So what you’re picking up on is that this really just isn’t represented. We have amazing celebrities that come out like Tyler Perry who disclose sexual abuse. But it’s not often enough and it’s often with a lot of snarky comments that are written, a lot of trolling, a lot of other things. And I think this really speaks to the toxic masculinity that’s prevalent in our society. The idea that men should be able to ward off sexual abuse or they’re quote unquote, not real men. And that’s something that kind of pervades even around more kind of socially correct, politically correct people. It’s still that idea of like grow a set, or just step up, or how could you let this happen? It’s still a lot of victim blaming that I know women face as well. But I think even more so around men, which just signals to us that there’s an issue in terms of how we view masculinity in general as a society.

Gabe Howard: I feel that we should point out that, of course, we’re not contrasting and comparing male to female assault and sexual abuse in any sort of competitive nature. It’s just that we want to make sure that everybody gets the help that we need. And your research has determined that there’s a lot of men that aren’t getting the support that they need. I mean, anybody who is sexually abused or sexually assaulted, raped deserves good care. And the fact that your research has determined that a lot of men are being left out of this conversation is obviously very problematic.

Dr. Joan Cook: I appreciate that very much, Gabe, because sometimes and this is what we’ve heard from male survivors, too. Sometimes when they go to survivor meetings, you know, they are seen as perpetrators instead of survivors of violence themselves. And so they’re not as welcome at the survivor table or some survivor tables. And then even when they go to some providers, providers have said like, you know, it’s not possible that you were assaulted or you must be gay. You must have wanted it. And so all of those myths and stereotypes keep people from getting the help that they need and deserve. And working on their path to healing. And also, like you said, it is not a competition. Everyone deserves this kind of validation and attention and help improving their lives.

Gabe Howard: I could not agree more. Amy and Joan, let’s get into the meat of your research. One of the first questions that I have is what are the differences in prevalence rates and clinical presentations of men and women with sexual assault abuse histories?

Dr. Joan Cook: The rates aren’t vastly different. As I’ve mentioned earlier, it’s one in six men before their 18th birthday and then that number increases to one in four. Women do have higher rates. The CDC estimates that one in three women experience sexual assault or violence in their lifetime. The presentation, the PTSD, the substance abuse, the depression, anxiety, the suicidal ideation seems somewhat similar. Both sets of sexual abuse survivors experience it. It seems to us clinically that there’s some very prominent psychological symptoms that men have that don’t fit neatly into our diagnostic classification system. So oftentimes with men who’ve experienced sexual abuse, we see intense anger and it’s always there and it’s always seething. But it particularly comes out when they’re feeling threatened or betrayed. We see a lot of shame, a lot of feeling damaged and worried about their masculinity. We see quite a bit of sexual dysfunction, including low sex drive, erectile problems. There’s a lot of chronic pain, difficulties with sleeping. And believe it or not, you know, we don’t talk a lot about men who have eating disorders or difficulties, but we see that as well, including some negative body image. One thing also that we don’t talk about and probably, too, because this carries some shame, is that we see higher rates of sexually transmitted infections, increased sexual risk for HIV and higher sexual compulsivity. And so I think when they present to us clinically and if they’re not acknowledging a sexual abuse history and not because of their own shame, though, that could be, it could also be they haven’t been able to acknowledge it or label it accurately themselves and then connect that experience to the symptoms that they’re having, that I think we’re treating them for other difficulties instead of what’s really driving their symptoms. So they’re getting inadequate treatment.

Gabe Howard: What are some of the barriers that men face in disclosing sexual abuse and their sexual assault histories?

Dr. Amy Ellis: Well, I think it goes back to that concept of toxic masculinity. And so there’s a lot of cultural influences. So, you know, men are supposed to be powerful and invulnerable. And there’s this idea that men should always welcome sexual activity. So you’ve kind of got this just societal barrier around people wanting to come forward. And I think also it boils down to the consequences of disclosure. So are people going to regard your sexual orientation, make some sort of assumption that because you were sexually assaulted, or you must have wanted it or it says something about you. It could even just be about the risk factors involved, coming forward and wondering if you’re going to actually face more violence or more discrimination as a result. So there’s a lot of negativity there, a lot to be afraid of in terms of coming forward and that disclosure. Joan had alluded to it earlier as well, if you’re going to your doctor and your doctor also disbelieves in these things, you might be repeatedly getting shot down. And so disclosure just isn’t a safe option. I mean, honestly, it also boils down to a lack of resources or a lack of awareness of certain resources. There’s a few non-profits out there that are dedicated to working with masculine identifying individuals. And you have to know that there is a trauma in order to seek out these resources. A lot of men wouldn’t use the label of I’ve been traumatized. I’ve been sexually abused. They just don’t use that language. So really trying to capture men and their experiences and then having them be aware of what might be out there for them.

Gabe Howard: You spoke a couple of times about some of the myths that people believe about male sexual assault survivors. One of them is their sexual orientation. One of them is whether or not they’re strong. What are some other common myths regarding the sexual assault of boys and men?

Dr. Joan Cook: The first, and one of the largest, is the myth that boys and men can’t be forced to have sex against their will. And the truth is, the fact is, is that any individual can be forced to have sex against their will. If someone doesn’t want to have sex or is not able to give fully informed consent, then they’re being forced into unwanted sexual activity. Another huge one is that men who have an erection when assaulted must have wanted it or they must have enjoyed it. And the truth is that many, if not all the men that we work with have experienced unwanted or unintentional arousal during a sexual assault. Just because a man gets an erection in a painful, traumatic experience does not mean they want it. And that kind of arousal from abuse can be confusing for survivors. But what Amy and I say to the people that we work with, and the people that are participating in our large research study, is that like our heart beat or shallow breathing, physiological reactions occur like erections and they’re outside of our control. And that doesn’t mean that you brought it on. There are others, too. We could go on and on. Sadly, there’s many. One that we were reminded recently talking to one of the male survivors who lead these peer led interventions that we have is that if you are abused by a woman, the myth is that you should welcome that. So, you know, hooray for you. And the truth is, no, you should not welcome that at all. So people believe that if an older woman abuses a younger man, that should be considered a good thing. And it’s certainly not. It can have devastating consequences.

Gabe Howard: And we’ve seen this play out nationally more than once where a teacher will sexually assault a teenager. You know, a 12, 13, 14 year old and an adult woman is sexually taking advantage of that person. And we hear the jokes. They’re very common. And I remember this portrayal on South Park where all of the police officers were saying nice and giving the kid five and

Dr. Amy Ellis: Oh, yes.

Gabe Howard: The kid was traumatized. And to South Park’s credit, which I never thought I’d be saying on the show,

Dr. Joan Cook: [Laughter]

Gabe Howard: They were showing how stupid that is. The young boy was portrayed as traumatized. The teacher was portrayed as an abuser, and nobody wanted to do anything about it except for the young boy’s parents. And how ridiculous that looked. Again, very odd that I would bring up South Park in this space. But I do think that they did a good job showing how ridiculous it is that we’re OK with an adult having sex with a child and we all want to give people high fives.

Dr. Amy Ellis: Yeah. It goes right back to those barriers because if you see that happening around you, then why are you going to step forward and disclose? There is a lot to be fearful of. And to be invalidated about.

Gabe Howard: I completely agree with that. Especially for trauma, because sometimes we don’t know how we feel about traumas. We feel that something is wrong. But if the people that we trust the most are praising us, that can be very confusing, right? If the older adults in our lives are like, yeah, that’s great way to go. And you’re like, I feel badly about this, but that’s not what I’m hearing from the people in my life whom I trust.

Dr. Amy Ellis: Absolutely. And so really, family support, peer support, those are actually protective factors. So even when a child is sexually abused, knowing that they have their parents that they can turn to or peers who will be receptive or even school officials who will hear that and validate those experiences, that actually kind of staves off some of the negative consequences of traumatization. And so it really just speaks to the power of being believed. One of the most staggering statistics to me is that on average, men take 25 years to disclose their sexual abuse. That’s almost a lifetime, that’s a quarter of a lifetime of

Gabe Howard: Wow.

Dr. Amy Ellis: Keeping that locked up and inside. And yet we know disclosure and having social support are key factors in someone’s recovery and healing.

Gabe Howard: Please correct me if I’m wrong, but in this case, it’s not a matter of being believed because the adults and the authorities may believe you. They just don’t care or they don’t think that it’s anything to be worried about. So that’s two problems. Problem number one is will I be believed? And problem number two is will I be taken seriously? And I imagine that this is what leads to the statistic of it taking 25 years for a male to report, because they want to make sure that they have their own arsenal, their own agency, or maybe that’s how long it took to meet somebody whom they trust enough to be by their side. I would say probably stereotypically a spouse or maybe other male survivors.

Dr. Joan Cook: Amy and I conducted a number of focus groups a few years back with a variety of survivors, different ages, different race and ethnicities, different sexual orientations. And one of the key things people told us was that they wish we could get to boys and men and help prevent this. And if we couldn’t help prevent this horrible event and for some people, it’s not a single event. It’s ongoing or it happens to them once and then they get revictimized again by someone else at a later point in their life. They said, if you can’t help us to prevent this, can you please help us get to boys and men who’ve had this experience? Help us get to them sooner and help them heal from this. And know, they’re not alone. And one way to do that, that Amy and I have really tried to catapult and take it to the next level is giving people the validation and the support through other male survivors, through peer support. That’s what our latest grant is focused on.

Gabe Howard: We’ll be right back after these messages.

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Gabe Howard: We’re back with Dr. Amy Ellis and Dr. Joan Cook discussing male survivors of sexual abuse and assault. Let’s shift gears over to treatment. What are some common treatment themes for male survivors?

Dr. Amy Ellis: First and foremost, when we’re considering treatment, it really starts with defining trauma and traumatization. So as I said, a lot of men do not label their experiences as trauma. That word carries a lot of weight. They seemingly apply it towards combat trauma or an accident and they tend to minimize experiences of unwanted sexual experiences. So just starting with identifying it and then also kind of determining the impact of that on their life, how their trauma has affected their relationships, their work, their symptoms of depression or anxiety, et cetera. As we’re talking about it, it starts to also play into defining and understanding masculinity. So really understanding how someone defines their own masculinity, how they define it in their particular cultural influences and then what their goals are around that. And so debunking these misconceptions or myths about male survivors could be a real focus of treatment. And then honestly, it’s treatment like any other treatment. Working on a lot of the other comorbid symptoms. A lot of men will present with depression and anxiety instead of the typical symptoms that we see in traumatization, post-traumatic stress disorder. And so it just really boils down to focusing on depression, anxiety, how things are playing out in the everyday here and now and tailoring our interventions to make sure that they are considering gender-based principles.

Gabe Howard: I think that people understand post-traumatic stress disorder when it comes to war, because we all acknowledge that war is awful, nobody wants to go to war, we never want to go to war again, it sort of has a good branding message, right? War is bad and it makes you sad. Whereas sexual assault, most people want to have a healthy sex life and they’ve been traumatized sexually. So I imagine that that causes some confusion. I think that it would be very, very difficult to have something that you like hurt you. We are sexual beings. So it’s a desire that most people have. So I can imagine all of those things working together. And then, of course, you take in all of the barriers and misconceptions. I’m starting to get a really good idea of how difficult this can be and how much work that you’ve had to put in to narrow down treatments that work and that men respond to. Is this what you found in your work?

Dr. Amy Ellis: I think you’re hitting it spot on in terms of some of the sexual considerations, you’re nailing down some other treatment themes. A lot of men will come in questioning their sexual orientation or their gender identity because of the experiences that have happened for them. And also exploring how to have a healthy sex life. So sometimes we’ll see sexual compulsivity or hypersexuality. Sometimes we see hyposexuality. So lack of sex drive or difficulties with maintaining an erection, as Joan had said earlier, too. So it is common for male survivors to come in and question and cope with some of these issues on a somewhat regular basis. And part of what helps is having that peer support, knowing, oh, you too. I’m not alone. So I think really the peer based support is what we have found really is aimed at healing.

Gabe Howard: Aside from peer support, which we’ve discussed and going to a therapist, what are some professional and community resources for men with histories of sexual abuse and assault?

Dr. Joan Cook: Well, there are quite a number of professional and community resources. Some of our favorites, there’s a wonderful non-profit organization, been around for at least 25 years. It’s called MaleSurvivor. It’s based out of New York City. It provides online free discussion groups for survivors and family members, chat rooms, a therapist directory. There’s another wonderful organization called MenHealing, which is based out of Utah. And they host weekends of healing, they call them, and they’re sort of retreats where you can go and meet other survivors. And they’re led by professionals. Certainly, within the APA, Amy and I have been very active in Division 56, which is the division of trauma psychology. And on their Web site, we developed free Web based resources for male survivors and for psychologists who are looking to work with male survivors clinically and research wise.

Gabe Howard: To shift gears a little bit along the same lines, what are some resources for family members and friends to help male sexual abuse survivors?

Dr. Joan Cook: On those Web sites, MenHealing and MaleSurvivor, they do have discussion forums and fact sheets that family members can go to and read about and see. I also like the V.A. has what’s called a National Center for PTSD. And on there they have, again, free factsheets, web resources, and they have incredible videos called About Face. And they feature veterans with a range of traumas, combat, military, sexual trauma, etc. And family members talking about the pain that they have experienced and the pathways to their healing. Some of the veterans who have a range of trauma experiences don’t receive the support and care that they deserve and their need. Understandably, their family members don’t understand or if they’re jacked up with their symptoms and they’re angry all the time. Those family members can be traumatized as well. So sometimes it’s not as easy for the veterans to explain themselves to their friends and family members. And it’s not so easy for their family members to come in and talk to a psychologist like me and Amy and receive psycho education and support. So sometimes these videos can be really helpful. So sometimes I will tell the veterans that I work with, ask your family member if they’re willing to sit privately, in the confines of their own home, and watch some of these videos and see some of the family members talk about their experiences. And sometimes it’s a little easier to be more empathetic to someone else than it is to be empathetic to your own loved one.

Gabe Howard: Joan, that is so true, we see that in substance abuse. We see that in mental illness. I am not surprised to hear how powerful peer support is, and I’m not surprised to hear how powerful it is to meet with other people outside of your friends and family to get the support you need, because this is big. This is a big thing. And you, you and Amy, have both taught me so much. Thank you. Thank you for everything. I really, really appreciate it.

Dr. Amy Ellis: Oh, my God thank you. Thank you for giving us this space.

Dr. Joan Cook: Exactly. We are in awe and extremely grateful. Thank you for helping us shed light on this very deserving and marginalized population.

Gabe Howard: Oh, it is my pleasure. Amy, I understand that you and Joan are running a study. Can you give us the details and where to find the study?

Dr. Amy Ellis: Yes, absolutely. We have a large study going on right now where we’re recruiting folks who are male, identifying sexual abuse survivors. And we’re going to be randomizing them to groups of their peers, led by male identifying peers who have gone through like 30 to 40 hours of training. And it’s six one and a half hour sessions that participants can go in to. So check out our Web site. It’s www.PeersForMensHealthStudy.com. We are actively recruiting through 2021 and we will just be constantly running groups over and over and over again as we get more people. And even if you are a professional, there’s our contact information on there, we’re happy to consult, talk, et cetera. If you have people you want to refer to or you just want to check out more about our team and what we’re doing, we’d love to connect with you. Always looking to spread the word and spread education.

Gabe Howard: Thank you so much, Amy. And please share the Web site with anybody you know who may need it. Again, it’s PeersForMensHealthStudy.com. And of course, the show notes will contain the link as well. Thank you all for listening to this week’s episode of the Psych Central Podcast. And remember, you can get one week of free, convenient, affordable, private online counselling anytime, anywhere, simply by visiting to BetterHelp.com/PsychCentral. Also, wherever you downloaded this podcast, please give us as many stars as you feel comfortable with. Use your words. Tell us why you like it. Share us on social media. If you have any questions about the show, you can hit us up at show@PsychCentral.com. Tell us what you like, what you don’t, or what topics you would like to see. We’ll see everybody next week.

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