November/ December 2013 Women, War, and PTSD

Are female warriors more likely to be traumatized by combat?

By Laura Kasinof

A year later, upon returning home to Texas, she couldn’t simply change back to who she’d been, she said. Instead, she found herself reaching for her guns when she heard a sound a night, feeling distant from her son, and being wracked with guilt. Now, years later, Keyte works for Olson’s organization, Grace After Fire, helping other women deal with the flood of emotions—including guilt about having been away or, sometimes, guilt that they don’t feel guilty—that they face upon leaving the military and rejoining family, friends, and children.

Sarah Mess, who served as an Army medic in Somalia in the ’90s, became a mother a decade after she returned from deployment—a role that, she says, has made her PTSD symptoms worsen. “I survived [my PTSD] because I was able to isolate. I could do those things because I was single, and I can’t do them now. Now I feel like I’m in a pressure cooker,” she told me when we met in the basement of a local arts center in New Jersey, where she joins other veterans once a week to make works of art out of their old military uniforms in a project called Combat Paper.

“Your four-year-old is there, and you better keep your emotions in, or else you’re going to fuck him up,” she said. “I pretend I’m okay and run into the bathroom so he can’t see me crying, and say, ‘Oh, I got something in my eye.’ It’s a poison, this PTSD, because it can affect other people.”

And then, of course, there’s the issue that’s received so much attention in the press of late: the prevalence of rape and sexual abuse in the military. While none of the women I spoke with for this story had suffered from military sexual trauma (MST), the armed services’ catch-all term, an estimated 20 percent of all women who use VA health care have been sexually assaulted, abused, or raped during their time in the U.S. military. Civil rights groups that get their stats from independent researchers put the number even higher, at around 30 percent.

Those huge numbers go a long way toward explaining why women react differently to war and carry different psychological burdens home with them, mental health experts say. Women in the military must also face “negative consequences for reporting [abuse or harassment] or they may have to continue working with someone who has assaulted them, or they were assaulted by a commanding officer,” said Janice Krupnick, research professor at Georgetown University’s Department of Psychiatry, who works with female veterans. “That adds an extra source of stress and difficulty.”

Even for women who don’t experience MST directly—like Pacanowski and Keyte—tamer versions of relentless sexual harassment can play a major role in inducing anxiety. Some of the female veterans I spoke with said that phrases associated with the female gender—like “acting like a girl” or “being a woman”—are often used as derogatory euphemisms for “weakness” during training drills and elsewhere. As a result, female soldiers feel the additional pressure to demonstrate that they’re just as tough as men. “It was a mentality that thought women should be barefoot and pregnant in the kitchen [and it] was told to my face,” Keyte told me. “That was the environment I was in. It made me more tough on people. I was tough on myself.”

So how do we determine whether women suffer more in war and its aftermath, or even that they suffer differently than their male counterparts? The short answer is that, as of now, we can’t. There has yet to be a definitive study looking at precisely this question, although there is a growing body of evidence suggesting that women may be more susceptible than men to specific psychological disorders, like PTSD and depression, especially in certain circumstances.

One landmark study, published by the APA’s Psychological Bulletin in 2006, examined twenty-five years of research on a wide spectrum of trauma and found that women are about twice as likely as men to develop PTSD after experiencing traumatic events. The study found that women were especially more likely to develop PTSD after types of assaultive violence, such as accidents, conflict, or physical abuse. A recent study by the University of California, San Francisco, also seemed to corroborate the APA’s research, finding that women develop a stronger conditioned response to fear than men, which may explain their increased propensity to develop PTSD after combat. A 2008 study by the RAND Corporation similarly found that female veterans were 1.7 times more likely to report PTSD symptoms than men and 2.4 more times likely to be depressed than their male counterparts, and several reports published by the VA’s National Center for PTSD found that women are more likely than men to develop the disorder.

A more recent study published in BMC Psychiatry in May 2013 by the Institute for Veterans and Military Families also found that female Marines who had been deployed to Iraq or Afghanistan were more prone to PTSD or depression than their male counterparts. “Research is needed to determine the factors responsible for these elevated levels of mental disorders among military women,” the report noted.

But all of those studies, however much they point at a trend, raise more questions than they answer. A May 2012 article published on the Web site of New York Behavioral Health, a mental health organization dedicated to treating psychological disorders of all kinds, noted that while there have been more studies focusing on biological causes for gender disparities in reactions to trauma, such as hormonal differences in the brain, there has yet to be a conclusive study on the matter.

Furthermore, most of the studies mentioned above rely on self-reporting or surveys—imprecise metrics at best, in part because it’s possible that women are simply more likely than men to report on their emotions. A different VA-sponsored study published in 2011 did not find a correlation between gender and PTSD, except when the trauma experienced was personal injury, in which case women were at greater risk for PTSD than men, but the study was based on mental health checklists that service members were required to complete upon returning from overseas service. The veterans I spoke with told me that no one fills out those checklists truthfully, because if they admit they’re struggling with PTSD-related symptoms, their trip home could be delayed by mental health exams.

Lisa Jaycox, a senior behavioral scientist at the RAND Corporation, where she coauthored a report on mental disorders among veterans, says that diagnosing and treating PTSD is complicated by the fact that men and women often exhibit different symptoms of the disorder. “Women are more prone to ruminate about problems, whereas men are more likely to distract themselves,” she said. Women often tend to blame themselves for their anxiety, spiraling into depression and social isolation; men are more likely to turn to substance abuse, or commit acts of violence.

Laura Kasinof is a freelance journalist based in Washington, D.C., where she is at work on a book about her three years as a reporter in Yemen. The reporting for this story was generously supported by the Fund for Investigative Journalism.


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