The National Defense Authorization Act (NDAA) of 2008 (HR 4986, Section 716) specifically "requires the Secretary of Defense to conduct a comprehensive review of the 1) need for gender and ethnic group-specific mental health treatment and services for members of the Armed Forces; 2) the efficacy and adequacy of existing gender-and ethnic group-specific mental health treatment programs and services for members of the Armed Forces." According to recent statistics, in 2008, women made up 11 percent of OEF/OIF veterans of the conflicts in Iraq and Afghanistan.

Although current law excludes active duty women from officially participating in certain job categories such as ground combat operations (e.g., infantry, armor, artillery units) and submarines, female military members are an integral part of the large support force for these and other operations. The lack of frontlines and the insurgent nature of the current conflicts have made avoidance of many combat situations very difficult. Female service members in combatant areas have had to fight the enemy in the same manner as their male counterparts: engaging in firefights, taking prisoners, and occasionally becoming casualties or prisoners of war.

As with male service members, female service members are at risk for exposure to combat-related incidents and trauma, which have the potential to result in post-traumatic stress disorder (PTSD) or other stress reactions. A comparison of male and female veterans from the Vietnam and Gulf Wars, however, suggests that when controlling for the level of combat exposure, males are three times more likely to be given a diagnosis of PTSD than females (Pereira, 2002).

One explanation for this may be cultural expectations that make it difficult for society and mental health providers to recognize women as combatants. Additionally, there may be a tendency in the mental health profession to diagnose women as having depression, anxiety and borderline personality disorder instead of combat-related PTSD (Becker, 1994).

A potential barrier for women needing treatment for mental health issues related to combat trauma is their need to show the emotional strength expected of military members. The self-image of the woman veteran may serve as an additional obstacle in obtaining treatment for military-related PTSD.

The DoD is working on a number of initiatives to support the psychological health needs of female service members. For example, the DoD/VA Strategic Working Group on the Psychological Health of Women Service Members and Veterans convened in October, 2008 to discuss clinical services, research and policy decisions that are vital to the psychological health of women in the military and veterans. The purpose of this meeting was to identify short-term and long-term goals for clinical programming, policy, and research related to women's psychological health in the DoD and VA systems. 

DCoE sponsored the first collaborative, scientific conference on Trauma Spectrum Disorders (TSD) to appropriately meet the challenges of closing the knowledge gaps and improve the identification and treatment of gender and race factors in psychological health and traumatic brain injury. It launched the two-day conference (October, 2008) with the National Institutes of Health and the VA. This conference examined the best existing science on trauma spectrum disorders in order to develop evidence-based concepts and strategies to better understand, assess and treat psychological health and traumatic brain injury, especially as it relates to service members (including women) and their families. DCoE will continue to address women's issues at the 2nd annual TSD conference scheduled for December to be held at the NIH's Natcher Auditorium, Bethesda, Md.

References:

Pereira , A, (2002). Combat stress and the diagnosis of PTSD in women and men veterans. Military Medicine, 167 (1).

Becker, D. (1994). Sex bias in the diagnosis of borderline personality disorder and posttraumatic stress disorder. Professional Psychology Research and Practice, 25, 55-61.