December 10, 2012

December 7th

The meaning of “December 7” may be different for those of us not old enough to remember WW II and the attack on Pearl Harbor.  It happens to be a day that reminds us of the many Americans now at war, particularly an increasing number of women.

We know that the US Defense Department now bans women from participating in ground combat (although there is now a federal lawsuit to overturn this ban).  But with about 14% of our military personnel being women, a disturbing new finding is that women in general are more likely to develop post-traumatic stress disorder (PTSD) than men.  Up to twice as likely, some researchers posit.

Post-traumatic stress disorder did not exist as a “formal” diagnosis until 1980, when it was added to the Diagnostic and Statistical Manual of Mental Disorders.  Prior to this, the terms shell shock, battle fatigue, or post-Vietnam syndrome were names given to various and severe adjustment problems experienced by recent war veterans.

A recent study at the San Francisco VA Medical Center found that women and men “learn” to fear differently.  This “fear conditioning” is vital to our safety, but in people with PTSD, a simple stimulus might trigger this stress or fear response.  Trash on the side of the road, or the smell of gasoline or fire may get associated with an actual traumatic military experience.  When female and male veterans were tested for reactions ranging from increased heart rate to rapid breathing when shown disturbing or violent images – and several of the images were paired with a slight electric shock,  women had more significant reactions.  The researchers believe this demonstrates that women may learn fear responses from different mechanisms, which may make them more susceptible to PTSD.

Patricia Resick and other researchers in the Women’s Health Sciences Division of the National Center for PTSD at Boston University are also seeking answers.  The group has linked significant diagnoses of PTSD to the types of trauma military women experience.  “In general, sexual trauma is a more significant risk for PTSD than combat or the types of trauma males in the military experience,” she reports.  “Combats, car accidents, or fights are impersonal events; when women are traumatized, it is often caused by the people who are supposed to love or protect them.”  When a fellow officer or commanding officer attacks a woman, the result is much more severe.

Sexual assault and severe sexual harassment - collectively known as military sexual trauma (MST) - is nearly epidemic in the armed service today . Amy Street, an assistant professor of psychiatry who leads a VA support team devoted to the issue, says that VA screenings for MST, mandated since 1992 for every veteran, reveal that 20%  of servicewomen report sexual assaults or severe, threatening harassment, compared to 1% percent of men.  And the numbers, she says, are most likely a gross underestimate. 

Many women veterans report that the sense of betrayal is compounded, and the trauma and shame intensified, when the chain of command fails to act on a reported incident, minimizes it, or even punishes women who report assaults.  Even reservists, the military part-timers who serve two weeks a year and one weekend a month, experience “high and impactful” rates of MST, among both women and men.  “So even people who had other lives outside of the military tended to experience a lot of harassment and assault,” Resick notes, “and even 10 or 20 years later, those experiences were associated with higher rates of depression, poorer functioning, and higher rates of PTSD.”

There’s much more to learn about the compounded effects of PTSD on both women veterans and women in the general population.  Because society doesn’t yet know how to understand the symptoms of PTSD in women, it’s much harder for them to find equilibrium.  And even with support from home, many female veterans also struggle because many do not see them as “real” veterans.

Since PTSD, its symptoms, diagnosis, and treatment may be very different for women than for men, it’s our work to raise awareness about this and other issues facing women and girls today.  Thank you for being a leader in this effort.