PTSD AND GENDER
Both women and men are at risk of enduring unfathomable trauma, but it’s important to emphasize gender differences here, with the hopes that they can ultimately be a much-needed catalyst for improved preventative measures, diagnosis, and treatment.
In 2006, Tolin and Foa reviewed the results of about 25 studies, and indicated that women are approximately 2x as likely to meet criteria for PTSD than men, and also approximately 4x as likely to have more chronic iterations of PTSD.
The question that is begged is, what might account for the higher rates of diagnosis in women?
- Women are NO more likely to experience trauma in general, but ARE more likely to experience certain types of trauma, including sexual abuse and assault. These types of trauma are associated with greater risk for PTSD.
- When compared with male trauma survivors, women tend to react with self-blame, belief that their incompetence lead to trauma, and coping skills that are maladaptive such as mental disengagement and suppression of traumatic memories. This seemingly gender-specific expression of emotional distress post-trauma might explain greater rates of PTSD in women.
- Increased baselines of anxiety and depression might put women at greater risk for developing PTSD. Most studies assess participants after trauma has occurred, without taking into account base rates of premorbid psychological distress. This limitation can inflate the risk of PTSD.
- Women are more likely than men to experience multiple traumas across their lifespan and the cumulative effects of repeated traumas likely increase their risk of developing PTSD.
Research directed toward specific details regarding gender differences and veterans is still scarce. It is incumbent upon any clinician, who is screening for PTSD and related difficulties, to be sensitive to this difference.
Female Veterans and PTSD
Women veterans are particularly at risk of being involved in different types of traumatic incidences. There are reports of being sexually (rape) and physically assaulted during military duty, as well as experiencing “duty-related” trauma as part of their military exposure (i.e., warzone exposure).
Also, it is not uncommon to hear that many women in the military have suffered preliminary trauma that might predispose them to the development of full-blown PTSD following a subsequent traumatic exposure.
Recently, research indicated that screening positive for PTSD is associated with a range of self-reported health problems and functional impairments specifically among female VA patients. These include fibromyalgia, stroke, irritable bowel syndrome, chronic pelvic pain, and obesity. In some studies, women reported poor health-related quality of life (HRQoL) relative to both male veterans and non-veteran women. Veteran women with PTSD have significantly more somatic distress, co-morbid medical conditions, psychiatric difficulty, and substance abuse rates than non-veteran women.
Female Veterans and PTSD + Chronic Pain
Women veterans specifically diagnosed with PTSD usually have significantly higher rates of pain and overall poorer health than women in the general population. There is not a lot known about the context of “military culture” that might have implications for women’s health behaviors. Yet, veteran women’s increased prevalence of chronic pain is probably because their pain is compounded upon by extreme conditions that are not experienced by civilian women. The ability to manage chronic pain is probably egregiously limited within military context, such that pain is probably maintained or progressively worsens with little relief.
When chronic pain cannot be readily explained as the direct consequence of tissue damage, some people treating veteran women are apt to think, “It is all in the head.” Although at greater risk for experiencing PTSD and co-morbid pain, women veterans are usually under-diagnosed and also under-use mental health services. A reason cited is that even in our progressed society, women in this position continue to be stigmatized.
I want to take a moment to mention the obvious: both PTSD and Chronic Pain sufferers are often stigmatized. They are relegated to the “outskirts” of the community, and become “liminal” creatures. I see time and again that those who experience either trauma and/or pain are perceived as victims of their own devices rather than just as sufferers.
Fibromyalgia is a common diagnosis given to women post-deployment. As such, women are stereotyped as somatisizers and told that their pain is elicited from the mental construct called the psyche, and not the brain. This concept of somatization implies that pain symptoms are exaggerated or feigned and ultimately within the control of the sufferer.
A variety of social and medical critics view chronic pain in women as a post-modern illness sharing a lineage with nineteenth-century pseudo-maladies like hysteria. These illnesses, they contend, originate in vulnerable human psyches. Central to these suspicions is the seemingly unshakable belief that chronic pain is a psychosomatic disorder, with the implication that the sufferer’s pain is not medically “real.” Within this conceptual framework is the archetype of the traumatized woman who experiences her trauma symptoms in her body. I urge women to take a stand against stereotyping and to pursue quality treatment despite critics who might make it seem unwarranted.
As always…this is a stigma-free, nonjudgmental, open community. Your comments regarding intellectual, theoretical, and, of course personal accounts of trauma are cared for here. We’d love to hear from you.
Jennifer Wolkin, PhD