Women And PTSD

In the population at large, women are more than twice as likely as men to develop posttraumatic stress disorder (PTSD), although the reasons why are not clearly understood.

There are several theories that often are mentioned:

• The most common trauma for women is sexual assault or childhood sexual abuse, and women are more likely than men to suffer these offenses.
• Women also are more likely to be the victim of domestic violence or to have a loved one suddenly die.
• There are differences in the way men’s and women’s brains work in processing emotions and actions and this, too, might be a contributing factor.

Certain PTSD symptoms seem to be more common in women than men, according to the National Center for Posttraumatic Stress Disorder. Women with PTSD are more likely to be jittery and anxious and to have more trouble feeling emotions. Men are more likely to feel anger and to have trouble controlling their anger. They also are more likely to experience the nightmares and flashbacks associated with PTSD.

Men with PTSD are more prone to alcohol and drug abuse, while women are more likely to suffer from depression.

One good statistic that women have going for them when it comes to PTSD: They are more likely than men to seek treatment for their symptoms. Some studies also indicate that women respond faster to treatment than do men.

Combat-related PTSD

In the wars in Afghanistan and Iraq, male and female troops suffer from PTSD at about the same rate.

Of the more than 1.6 million U.S. troops who have been deployed to Operation Enduring Freedom and Operation Iraqi Freedom, about 15 percent are women. While females are barred from ground jobs in infantry and from armor and artillery units, they perform important support roles that— in these wars where no formal combat lines exist— put them in highly dangerous posts.

Women troops are driving supply convoys, guarding checkpoints, searching combat-area neighborhoods— situations that can put them under direct fire. Women also comprise a large percentage of other highly stressful combat-related roles, such as mortuary workers and health-care personnel.

In 2006, nearly 3,800 women who had deployed to Iraq were diagnosed with PTSD and treated by the Department of Veterans Administration. These women accounted for 14 percent of a total 27,000 recent veterans treated for PTSD in 2006.

Like male service members, women may be reluctant to get treatment for combat-related stress injuries because they are concerned it will negatively affect their careers or make them appear weak.

"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," says the 2007 report of the Department of Defense Mental Health Task Force.

"The self-image of the woman veteran may serve as an additional obstacle in obtaining treatment for military-related PTSD. After their military service, many women no longer see themselves as veterans. Moreover, they may not associate symptoms of trauma exposure with their military service."

Military Sexual Trauma and PTSD

Military sexual trauma, known as MST, is a serious concern for all branches of the armed forces. Just how widespread a problem it represents is hard to gauge for a variety of reasons.

In a report delivered to Congress in March 2009, the Pentagon says there were 2,908 reports of sexual assaults involving either a military victim or perpetrator in fiscal year 2008. This is an 8.18 percent increase from the previous year, according to the Pentagon. The offenses range from wrongful sexual contact to rape.

The latest number could indicate that sex offenses are on the rise, more reports of offenses are being filed as service members are encouraged to report them, or a combination of both.

The military definition of sexual trauma is more inclusive than the civilian term. MST refers to both sexual harassment and sexual assault that occurs in military settings. Both men and women can experience MST, and the perpetrator can be of the same or opposite gender.

MST is associated with higher rates of mental-health problems. A study from the Department of Veterans Affairs looked at healthcare screening data of about 90,000 vets of the Iraqi and Afghanistan wars who were treated at a VA health facility between October 2001 and October 2006. Of these, about 14.5 percent of the women and 0.6 percent of the men report experiencing MST.

Both women and men with a positive MST screen were three times more likely to be diagnosed with a mental-health condition than patients who did not report MST, the study says. The most frequently reported mental-health conditions among OEF and OIF veterans were depression, PTSD and other stress disorders, and substance abuse.

Future Research

In a commentary* written in 2007, Charles W. Hoge, a leading researcher in the field of PTSD, summarizes what needs to be studied regarding women and combat-related PTSD. To better understand the relationship of direct combat to mental-health issues among women compared with men, he suggests researchers look at:

"... the specific nature of the combat experiences, the prevalence of mental-health problems prior to deployment, complicating factors such as sexual harassment or abuse in the deployed environment, and the trajectory of gender differences over time following return from deployment.

As further studies emerge it is likely that there will not be a simple conclusion about the relationship of gender and combat to the mental health of veterans of this war. The available data point to an important hypothesis that combat duty in Iraq or Afghanistan, due to the high intensity and persistent level of threat, acts as a great equalizer of risk, resulting in similar rates of PTSD and depression for men and women."

*Published in the International Journal of Epidemiology, March 2007