PTSD in Women Soldiers, Co-occurring Disorders

By Sandy Dechert, Examiner.com
 
In an exclusive interview with Examiner.com last week, Dr. Kimberly Dennis of Timberline Knolls shared the concept that most post-traumatic stress disorder (PTSD) among women in the military results from trauma due to interpersonal abuse (such as sexual abuse), rather than from combat duty.
Dr. Dennis expanded on survey and observational results on trauma’s role in later psychological damage, and a comprehensive approach to treatment, that she had reported at an annual conference on “Building Bridges to Recovery,” held in Brooklyn, New York, on October 21.
 
“Trauma exposure directly affects how the brain develops, especially in adolescents and small children,” Dr. Dennis explained. “An infant’s growing brain slowly develops different functions — like the capacity to attach to caregivers, the regulation of anxiety, or the capacity for speech.” If trauma occurs prior to the development of these functions, then the related part of the brain and all the functions that depend on it may fail to develop in a healthy manner. In an adult brain, PTSD can initiate profound changes. These include the development of co-occurring disorders such as substance abuse and depression.  Left untreated, these disorders can result in death or suicide.”
 

PTSD affects nearly 8 million Americans. It can develop in men or women at any age. Half of PTSD cases begin before age 23, and half after.
 
Women, Trauma, and PTSD


Gender plays an important part in the experience of PTSD. Five of every ten women experience a traumatic event in their lifetimes, only slightly fewer overall than men. However, women are more than twice as prone to developing PTSD as men are (10% for women, 4% for men).
 
Women also differ from men in their experience of PTSD symptoms. Men are likely to feel angry and to have trouble controlling their anger. Women tend to become jumpy, to have more trouble feeling their emotions, and to avoid things that remind them of the trauma. Also, women often take longer to recover from PTSD. They are four times more likely than men to have long-lasting problems.
 
Women are more likely to suffer PTSD after being neglected or abused in childhood, experiencing domestic violence, or having a loved one suddenly die. One of the most common traumas related to PTSD in  women, though, is sexual abuse, assault, or rape. “Sexual abuse is more likely to cause PTSD than other nonpersonal events a woman faces in her lifetime, including combat duty,” Dr. Dennis pointed out.
 
Rape > Trauma > PTSD


Early information on trauma and PTSD came from studies of male veterans, mostly from Vietnam. An article published in 2006 by Science magazine estimated 19% of Vietnam veterans experienced symptoms, including flashbacks and emotional detachment, at some point after the war. At the about same time, caregivers of female assault victims found that women’s reactions to sexual trauma were similar to those of male combat trauma veterans.
 
The national shift from the draft to all-volunteer forces in the mid-1970s gave women opportunities to serve in greater numbers. It also enabled the armed forces to meet personnel goals. Twenty years later, the US government allowed women to fly combat aircraft and serve on combat ships. Pentagon rules now forbid women to serve in ground combat, but allow them to offer support as truck drivers, gunners, medics, military police, helicopter pilots, and more.
 
With this new kind of war, which involves targeted mortar attacks, rocket-propelled grenades, and suicide bombs, women are actually seeing combat in greater numbers. “The unpredictable nature of the attacks in [the new theaters of Iraq and Afghanistan] blurs the distinction between front-line and rear areas,” says military sociologist Brenda Moore, of the University at Buffalo-The State University of New York.
 
Combat duty is a relatively new factor involved in women soldiers suffering PTSD, and thus interest in combat trauma and PTSD in women is growing. Despite this trend, Dr. Dennis posits that PTSD related to the incidence of sexual assault is just as common among military women, if not more so, as PTSD due to combat trauma.
 
Studies of women using the Veterans Administration health care system report that 28% experienced at least one sexual assault during military service. Over half of enlisted women have experienced sexual harassment in the military, the reserves, and the National Guard, or suffered sexual assault or harassment during their service. The phenomenon, both “offender-known rape” (date rape) and “rape by rank,” actually has a name — “Military Sexual Trauma.”
 
Co-occurring disorders


Dr. Dennis stressed that as well as triggering PTSD, trauma exposure can lead to other negative mental health outcomes for women. The National Institute of Mental Health estimates that nearly half of those with any mental disorder suffer from more than one problem at a given time. According to a 2005 report by R.C. Kessler in the Archives of General Psychiatry, the severity of PTSD strongly relates to “comorbid” or co-occurring, disorders.
 
For women, serious co-occurring problems include eating disorders — anorexia, bulimia, and compulsive overeating — which Dr. Dennis and her staff of psychiatrists, psychologists, nurses, expressive therapists, licensed clinical social workers, and other healthcare professionals treat daily at the Timberline Knolls facility. Almost one in every 20 Americans suffers from these problems at one time in their life. Very often, these disorders are also associated with depression, alcohol and drug abuse, self-mutilation, and suicide.
 

According to researchers at Duke University, nearly one-third of doctors have never brought up the topic of healthy weight with their patients. Those who did spent an average of only three and a half minutes on this life-sustaining topic.
Women are much more likely than men to develop an eating disorder. They are also three times as prone to anorexia and bulimia, and 75% more apt to have a binge eating disorder. Among women aged 15-24 in the general population, the annual mortality rate due to anorexia is about 12 times higher than the rate due to all other causes of death.
 
Trauma-informed intervention


Dr. Dennis and her team at the Timberline Knolls treatment center have developed an comprehensive, integrated, and intensive treatment for women with PTSD and co-occurring disorders. The residential therapy program focuses on identifying, engaging and maximizing each resident’s inherent strengths and overcoming her destructive patterns of thought and behavior. Reintegration of the person’s pre-trauma concept of a loving higher power is also a key part of the healing provided by the center.
 
Dr. Dennis noted that after treatment, women tend to experience improvement occurs in trauma and mental health symptoms. Those with alcohol abuse or dependence have significantly fewer days of substance abuse, and drug use trends in the same direction. In line with what clinical research has demonstrated for many of the mental illnesses, Dr. Dennis has concluded that trauma-informed intervention and integrated treatment provide optimal outcomes for women with PTSD and co-occurring disorders.
 

Source: http://www.examiner.com/women-s-health-in-chicago/ptsd-women-soldiers-combat-stress-or-rape