PTSD Women Combat Veterans

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Women and Combat-Related PTSD

Running head: WOMEN VETERANS WITH POST-TRAUMATIC STRESS DISORDER.

Specific Problems of Women Combat VeteransSuffering From Post-Traumatic Stress Disorder.

M. S. Pilgrim, M.A.

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Post traumatic stress disorder (PTSD) in an anxiety spectrum disorder that differs

from many other mental illnesses in that it is related to a persons perceptions and

subsequent adjustment to a life-threatening event or series of traumatic events (DVA,

2007). It is not whether the event was truly life-threatening that matters so much as it is

the victims perception that their life was in jeopardy, and their emotional reaction to it

was fear, helplessness, or horror. In order for a person to be diagnosed with PTSD,

according to the APA (2000), they must not only have experienced the event as

described, but also reexperiencing it and have a clinically significant impairment in their

daily functioning for at least one month. Reexperiencing may be by several means:

repeated and intrusive memories, dreams, experiences in which they feel that they are

currently in the midst of the event (including dissociative events or hallucinations) and

may also include the development of specific phobias that trigger intense distress when

exposed to certain stimuli that symbolize, for the sufferer, the event. The criteria for

triggering symbols of the event is important, because a positive diagnosis for PTSD also

depends on the sufferer to go to extreme lengths to avoid any and all reminders of the

event and anything that has come to symbolize it. This may include a dissociation, or

numbness in which the person retreats from the strong feelings about the event and the

stimuli that has come to symbolize the event, and may include talking about it, any

place or person that represents it.

These difficulties cause such severe impairment that the individual eventually

stops participating in activities in their life that they engaged in before the trauma, and

as a result of the horror, fear, and the sufferer may exhibit and/or experience a range of

signs and symptoms related to the traumatic event such as feeling detached from

others, restricted affect, and feelings of hopelessness with regard to their future life

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prospects. Other symptoms include sleep difficulties, difficulty with anger management,

problems with concentration, being overly aware of their surrounding, and what may

seem as reactions that are very strong with respect to their stimuli.

The treatment for PTSD varies, but empirically based research indicates that the

best treatment includes educating the client about their condition and ensuring that the

client has opportunities to feel safe; cognitive-behavioral therapy (CBT) has been most

successful in improving the more debilitating symptoms of PTSD (Cahill, 2004). Group

therapy is also found to help reduce the feelings of isolation in the client. Specific CBT

techniques include exposure therapy and stress-inoculation training.

Exposure therapy involves carefully exposing the client to either real or imagined

images of the trauma repeatedly until they no longer trigger severe anxiety (Keane, et

al., 1989). Stress inoculation training (SIT) is psychoeducational in nature. It helps

clients to learn to view perceived threats and as problems that they can solve, and to

view their reactions as something that they have control over, as well as to identify

which situations and reactions that are or are not changeable. The clients are taught

how to reduce stressors to specific coping goals as they pass through three phases of

the treatment: 1) First, they establish a therapeutic alliance with the client, 2) learn and

practice specific skills in coping with stress, and 3) learning to follow-through with using

the skills in real life (Meichenbaum, 996).

Combat duty of members of the military lends itself to an increased opportunity

for the development of PTSD, due to the horrific nature of war and the perceptions of

immanent danger. In addition, because of the increased life-preserving ability of

modern medicine, more combat troops survive major combat but carry with them the

memories of their experiences. Hoge, et al reported early findings in 2004 among over

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3,000 soldiers deployed to serve in the Operation Enduring Freedom and Operation

Iraqi Freedom (OEF-OIF). Three-fourths of those who had been deployed had engaged

in at least one firefight for those in Iraq, and more than a tenth of those deployed to Iraq

were wounded or injured. Their problems, at that time, already included major

depression, generalized anxiety, and PTSD that rose from 9.3% prior to deployment to

between as high as 17% after deployment.

Prognosis is highly dependent on a number of factors related to both the event

and the individual and his or her surroundings. King, et al (1998) found that the degree

to which the experiences were considered horrific, the perceived threat, and the degree

to which the environment in which the experiences were occurring all affect the PTSD

severity of symptoms, but these can be mediated to some degree by the resilience of

the individual and how stressful their life is upon returning from combat. All of these, in

turn are mediated by the amount of functional social support the veteran receives.

Women combat veterans have a unique experience in the military because of

what has come to be known as military sexual trauma, or MST. MST includes sexual

harassment, sexual assault, and rape. A report released the House Committee on

Veterans Affairs (Street, et al, 2003) indicated that the rate of MST among women in the

reserves in 2001 was as high as 60%, with 11% of women in the military reporting that

they had been raped (compared with 27% and 1.2% for men, respectively).

It can certainly be argued that any sexual trauma can be considered a stressful

life event, and to be harassed consistently in ones living and workspace would affect a

persons likelihood of developing PTSD, as well as the severity of symptoms. MST is an

unusual stressful life event, particularly because afterwards those who experience it

must continue working and living with those who perpetrated the trauma upon them,

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without the option to leave. Indeed, a research finding by Katz, et al found in a small

sample of women veterans that 56% of those returning from OEF-OIF had experienced

MST, similar to the previous findings, and that those who had experienced MST had a

more difficult time adjusting after returning from combat duty. More surprisingly, Katz

and his collegues found that MST was a greater factor in adjustment after combat than

was the severity of the experiences that women had suffered related to combat itself.

Because this area of research is new, there are only a small number of studies

published. However, it is important to know that the experiences of women combat

veterans returning from military deployment are mitigated by different factors than those

of men; as this should drive to particular treatment approach used by clinicians and

understanding this client. Hopefully, there can also be some movement in the future to

begin investigating and prosecuting MST-related events in order to protect this segment

of the military.

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References

American Psychiatric Association (APA), (2000). Diagnostic and statistical manual of

mental disorders, fourth edition, text revision (DSM-IVtr). Washington, DC:

Author.

American Psychological Association. (2002). Publication manual of the American

Psychological Association (5th ed.). Washington. DC: Author.

Department of Vetarans Affairs, (2007). A Fact sheet on PTSD. Unite States

Department of Veterans Affairs. Available Online,

http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_lay_assess.html.

Accesssed March 25, 2008.

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Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). The treatment of

posttraumatic stress disorder in rape victims: A comparison between cognitive-

behavioral procedures and counseling. Journal of Consulting and Clinical

Psychology, 59, 715-723

Hoge, C., Castro, C., Messer, S., McGurk, D., Cotting, D., and Koffman, R., (2004).

Combat duty in Iraq and Afghanistan, mental health problems, and barriers to

care. New England Journal of Medicine, 351, 13-22.

Katz, L., Bloor, L., Cojucar, G., and Draper, T. (2007). Women who served in Iraq

seeking mental health services: Relationships between military sexual trauma,

symptoms, and readjustment. Psychological Services, 4(4), 239-249.

Keane, T. M., Fairbank, J. A., Caddell, J. M., & Zimering, R. T. (1989). Implosive

(flooding) therapy reduced symptoms of PTSD in Vietnam combat veterans.Behavior Therapy, 20, 245-260.)

King, L., King, D., Fairbank, J., Keane, T., and Adams, G. (1998). Resilience-recovery

factors in Post-Traumantic Stress Disorder among female and male Vietnam

veterans: Hardiness, postwar social support, and additional stressful life events.

Journal of Personality and Social Psychology, 74(2). 420-434.

Meichenbaum, D. (1996). Stress inoculation training for coping with stressors. The

Clinical Psychologist, 49, 4-7. Available online,

http://www.apa.org/divisions/div12/rev_est/sit_stress.html, Accessed March 20,

2008.

National Institutes of Health (2007). Post-traumatic Stress Disorder: A Real Illness.

National Institutes of Health NIH Publication No. 05-4675. US Department of

Health and Human Services, Online,

http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-a-real-

illness/complete.pdf . Accessed March 21, 2008.

Street, A., Mahan, C., Hendricks, A., Gardner, J., and Stafford, J. (2003). Military

Sexual Trauma Among the Reserve Components of the Armed Forces. Final

Report to Congress, Veterans Millenium Health Care and Benefits Act, Public

Law 106-177. Available online:

http://veterans.house.gov/democratic/press/109th/pdf/mstreport.pdf. Accessed

March 10, 2008.

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PTSD Women Combat Veterans