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M. S. Pilgrim, M.A.
Women and Combat-Related PTSD 2
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
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
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
Women and Combat-Related PTSD 3
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
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
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
for the development of PTSD, due to the horrific nature of war and the perceptions 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
Women and Combat-Related PTSD 4
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
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.
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
unusual stressful life event, particularly because afterwards those who experience it
must continue working and living with those who perpetrated the trauma upon them,
Women and Combat-Related PTSD 5
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
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.
References
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.