The current study examined the prospective association between alexithymia and the persistence of trauma symptoms in a clinical sample of 175 male and female veterans who experienced sexual trauma during military service (military sexual trauma; MST). Trauma symptoms decreased significantly over the course of a specialized residential treatment program. Difficulty identifying feelings was related to persistence of the following trauma symptoms: overall symptoms, sexual abuse trauma symptoms, dissociative symptoms, and anxiety. Men exhibited more persistent symptoms overall, more persistent sexual problems, and more sexual abuse trauma symptoms compared with women (over and above controlling for symptoms at intake). The results speak to the significant role that difficulty identifying feelings has in the treatment of PTSD. In addition, the results suggest that MST has different implications for men compared with women. Specifically, men who were sexually abused in the military experienced greater persistence of symptoms compared with women, especially in the areas of sexual functioning.