Haunted by memories

Lack of support may also help explain why women in the military are more likely to suffer from PTSD than men: already in the minority, they may face pressure to hide their emotional disturbances from those who might be able to help. At the same time female soldiers are exposed to more and more potentially traumatic experiences. Although women in the military are not technically allowed to serve as infantry, “Things are changing in these current wars,” says Vogt, of the National Center for PTSD. “A lot more women are getting exposed to combat circumstances. These are the kind of wars where there’s no front line.”

And one in five women in the military isn’t just exposed to potential trauma from combat, but from sexual assault or persistent sexual harassment as well. This creates the possibility for multiple simultaneous sources of trauma. While this is not a combination unique to women — men report sexual trauma from military experience, but at a much lower rate — new studies will focus on how female soldiers deal with exposure to multiple potentially traumatic events at once. “The next big question is really to look at the combined effect of military sexual trauma and combat and how that affects women,” Vogt says. According to Vogt, female veterans suffer from PTSD at a rate of about one in five, compared to one in twelve for men. Researchers hope that findings from these new studies will help mental health care providers both lower the incidence of PTSD in women in the military and the general population and continue to improve treatments for those that do suffer.

A combination of biological, psychological and social factors may also make women with PTSD more prone to suffer certain symptoms than male victims. Men, studies show, are more likely to externalize their responses to trauma, through anger or aggression. Women are more likely to turn inward, and rates of depression, anxiety and attempted suicide spike in women with PTSD.

Vogt says that in a broad sense PTSD looks similar in men and women, but gender differences emerge when looking at specific symptoms. There is “evidence that women are more likely to be jumpy, to have trouble controlling emotions, [to be] more avoidant,” she says. “Women may be more likely to blame themselves for their trauma experiences than men,” possibly a reason that they are more likely to become depressed or suicidal when dealing with PTSD. Men, however, are “more likely to have trouble controlling their anger.”

Women also seem to take longer to recover from PTSD than men. According to the 1996 Detroit study, women with PTSD retained the diagnosis for an average of four years, compared to one year in men. This difference occurs even though the same treatment methods are used in men and women.

The most common PTSD treatment is cognitive behavioral therapy, which aims to help patients focus on how thoughts influence emotions. CBT is often used in conjunction with antidepressant medications like Prozac and Zoloft. “CBT treatments are being used for both men and women, and they appear to work for men and women,” Vogt says.

One type of cognitive behavioral therapy is called prolonged exposure, the technique Edna Foa, the director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania School of Medicine, uses with PTSD victims. “The treatment that we’re talking about is a kind of revisiting of the traumatic event,” she explains. By going over their memories in a safe space, patients’ emotions surrounding a traumatic event may eventually be relieved. With their therapist, patients start to ease into situations that used to trigger traumatic memories. Using this therapy system, Foa says that 80 to 85 percent of patients cut their symptoms in half over time, and some recover completely.

Beverly Smith is determined to become one of those treatment success stories. Though she still suffers from depression and sometimes finds herself crying without being provoked, Smith’s PTSD symptoms have improved. Two psychiatric drugs have helped with her depression, as have exercise and hypnosis. She’s in a group therapy program that she says has helped her learn coping skills and is working to get nurses trained to be on the lookout for PTSD in other cancer patients. “That kind of stuff is what helps me not sit around and feel sorry for myself,” she says.

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