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When Mommy Comes Marching Home:
Women in the military are developing PTSD at alarming rates.

Michele Parkinson survived the near-daily bombings in Kirkuk. She managed the blood. She handled the nausea as she picked through the pockets of a corpse, searching for an ID. What she couldn't get through, it turns out, was a trip to the pharmacy back home in Massachusetts.

A sergeant first class in the National Guard, Parkinson had been evacuated from Iraq in 2005, suffering from severe and medically mysterious headaches. When she arrived at Fort Dix, she thought she was home free. And she felt fine — as long as she was in the company of other soldiers.

On a trip to the National Cemetery in Washington, D.C., she left her group of fellow soldiers to use the restroom. "When I came out of the stall, it seemed like there were a thousand women standing there," she recalls. "It was maybe about 20. I went into a panic. I couldn't breathe, I started shaking. I pushed my way out, and I ended up falling to my knees. When I looked around and saw my soldiers standing there, I calmed right down.

“That was the beginning of it.”

Within days of arriving home, says Parkinson, she started to experience extreme anxiety. One day at her pharmacy, she started to shake, and broke down in tears.

“I just totally lost it,” she says. “For 10 days I couldn’t walk out my door without breaking down.”

Parkinson is among the 190,000 military women who have served in Iraq and Afghanistan since 2001. And she’s among the 20 percent of servicewomen who develop post-traumatic stress disorder (PTSD), a debilitating, life-threatening anxiety disorder that may affect as many as 300,000 veterans of the current wars.

When we hear about military-related PTSD, it’s mostly in worst-case scenarios: damaged men doing destructive things when they return from service. But women develop PTSD at more than twice the rate men do. Their suffering, generally quieter, is far less publicized, far less researched, and until recently, far less treated. Before this war, its primary cause was sexual trauma, not combat trauma. But now, with women returning from combat deployments in greater numbers than ever before in U.S. history, the Department of Veterans Affairs is scrambling to meet a need whose scope is still unknown.

Much of the research to determine the need and shape a solution is being conducted at the VA’s National Center for Post-Traumatic Stress Disorder, many of whose leading investigators are Boston University professors who do their work at the VA Boston Healthcare System in Jamaica Plain.

Deconstructing PTSDs

Post-traumatic stress disorder didn’t exist as a diagnosis until 1980, says Terence Keane, a School of Medicine professor of psychiatry, who is the director of the Behavioral Sciences Division of the National Center for PTSD and who developed many of the most widely used PTSD assessment tools. That’s when it was added to the Diagnostic and Statistical Manual of Mental Disorders, thanks to a research push in the 1970s by Keane and other pioneers in the field.

But long before then, medical professionals understood that the effects of trauma added up to a persistent set of symptoms in many thousands of sufferers. Shell shock, battle fatigue, post-Vietnam syndrome: these were a few of the names given to the severe adjustment problems experienced by some veterans of 20th-century wars. As researchers began looking closely at what was happening with Vietnam veterans, others noticed remarkably consistent symptoms in some women who had been sexually assaulted and raped — a condition then called rape trauma syndrome — and in Holocaust survivors, who suffered from what was referred to as KZ syndrome.

“These researchers started to communicate with each other,” Keane says, building a body of evidence for a single diagnosis that wasn't specific to the origin of the traumatic experience.

Researchers now believe that 20 to 25 percent of people exposed to a traumatic event will develop PTSD, Keane says. The diagnosis encompasses four types of symptoms: reexperiencing, reliving the trauma through nightmares and flashbacks, sometimes brought on by triggers like a car backfiring; avoidance, compulsively steering clear of places or people even loosely associated with the trauma, working too much, or drinking too much; numbness, a lack of warmth for family members, a lack of trust, a lack of interest in favorite activities; and hyperarousal, a jittery sense of panic, a constant state of alert, trouble sleeping, trouble concentrating, and irritability.

These symptoms can become powerfully destructive. They can lead to substance abuse, broken relationships, unemployment, and suicide. And they can result in physical illnesses like obesity, heart disease, and diabetes.

Why some people are resilient in the face of trauma and others are not is a matter of continuing interest. “PTSD appears to develop in people who’ve had multiple exposures to trauma, and also different kinds of exposure,” Keane says. Past trauma is like kindling, providing fuel when new trauma occurs.

Another risk factor, it turns out, is gender. Epidemiological studies in the 1990s helped establish that women, although less likely than men to be exposed to a traumatic event, are much more likely to develop PTSD. The reason is unclear.

Traumatic triggers

Patricia Resick and other Boston University researchers in the Women’s Health Sciences Division of the National Center for PTSD are looking hard for answers, studying the psychology, psychobiology, and treatment of the disorder in women veterans. Their work is just now starting to fill large gaps in a field where the vast majority of research has been done on men.

One thing they would like to know is why 20 percent of women in the military develop PTSD, compared to only 8 percent of men. Resick, a professor of psychiatry and psychology and the director of the women’s division, says that some of it has to do with the kind of trauma women experience.

In general, whether in the military or out, sexual trauma is a more significant risk factor for PTSD than combat or the types of trauma that men generally experience, says Resick. “Combat, car accidents, fights — those are impersonal events,” she says. “When women are traumatized, they’re often traumatized by people who are supposed to love or protect them.” In a military setting, “your commanding officer is an authority figure who is supposed to protect you,” she says. “Your fellow officers or soldiers are supposed to have your back. So when one of them attacks you, it’s a huge betrayal.”

Sexual assault and severe sexual harassment — collectively known as military sexual trauma (MST) — is nearly epidemic in the armed services. Amy Street, a MED assistant professor of psychiatry, who leads a VA support team devoted to the issue, says that VA screenings for MST, mandated since 1992 for every veteran, reveal that 20 percent of servicewomen report sexual assaults or severe, threatening harassment, compared to 1 percent of men. Those numbers, she says, are probably an underestimate. And many women veterans report that the sense of betrayal is compounded — and the trauma and shame intensified — when the chain of command fails to act on a reported incident, minimizes it, or even punishes women who report assaults.
Street recently found that even reservists, those military part-timers who serve two weeks a year and one weekend a month, experience “high and impactful” rates of MST, among both women and men. “So even people who had other lives outside of the military tended to experience a lot of harassment and assault,” she says, “and even 10 or 20 years later, those experiences were associated with higher rates of depression, poorer functioning, and higher rates of PTSD.”

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