If the words "posttraumatic stress disorder (PTSD)" bring to mind battle-scarred men returning from war, you're not alone. "Until the last 15 to 20 years, we thought of PTSD as battle fatigue," said Jerilyn Ross, LICSW, president and CEO of the Anxiety Disorders Association of America (ADAA). Today, she said, "we know you don't have to go to war to develop this."
In fact, most PTSD in women results from sexual trauma, while the most common cause in men is combat. As with other anxiety disorders, women are more likely than men to develop PTSD when exposed to traumatic events, a difference that may be related, in part, to differences in the way men and women's brains work to process emotions and actions.
Not surprisingly, it turns out that women veterans have much higher rates of PTSD than women in the general population. Overall, studies of female veterans estimate the lifetime prevalence of PTSD at 27 percent, nearly two-thirds higher than the 10 to 12 percent seen in the general population. While this is still lower than rates in male veterans, experts suspect female veterans are under-diagnosed and the rates are similar.
Most people experience reactions such as intrusive memories of the event, nightmares, problems sleeping and irritability after a traumatic event such as a car accident, rape, physical assault or natural disaster. These common stress reactions usually decrease in the weeks and months after the event. However, they persist in some individuals over time, resulting in posttraumatic stress disorder.
Symptoms involve re-experiencing the trauma in flashbacks or nightmares, avoiding reminders of the trauma, an emotional numbness, exaggerated startle response and, often, depression. Women are also more likely than men to exhibit somatoform pain disorder, in which they experience excruciating pain with no obvious physical reason, and their illness may last up to four times longer than men's.
Treatment involves cognitive behavioral therapy in which the person with PTSD practices confronting memories and confronting reminders of the traumatic event, said Jonathan S. Abramowitz, PhD, who directs the Anxiety and Stress Disorders Clinic at the University of North Carolina in Chapel Hill. "She also learns that the anxiety response is normal after traumatic events and is taught not to take responsibility or feel guilty for anything inflicted on her." Medication is often used, particularly serotonin selective reuptake inhibitors like sertraline (Zoloft) and paroxetine (Paxil), which some evidence suggests may work better in women with PTSD than in men.
References
Breslau N. Gender differences in trauma and posttraumatic stress disorder. J Gend Specif Med. 2002;5(1):34-40.
Breslau N, Davis G, Andreski P, et al. Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry 1997;54(11):1044–8.
Breslau N, Kessler RC, Chilcoat HD, et al. Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 1998; 55:626-32
Breslau N, Davis G, Peterson E, Schultz L. Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry 1997;54(1):81–7.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-1060.
McClure EB, Monk CS, Nelson EE, et al. A developmental examination of gender differences in brain engagement during evaluation of threat. Biol Psychiatry. 2004;55(11):1047- 1055.
Pereira A. Combat trauma and the diagnosis of post-traumatic stress disorder in female and male veterans. Mil Med. 2002;167(1):23-27.
Pigott TA. Anxiety disorders in women. Psychiatr Clin North Am. 2003;26(3):621-672, vi-vii.
Zinzow HM, Grubaugh AL, Monnier J, Suffoletta- Maierle S, Frueh BC. Trauma among female veterans: a critical review. Trauma Violence Abuse. 2007;8(4):384-400.
© 2008 National Women’s Health Resource Center, Inc. (NWHRC) All rights reserved. Reprinted with permission from the NWHRC. 1-877-986-9472 (toll-free). On the Web at: www.healthywomen.org.