A growing problem

Learning more about PTSD in both women and men in the military takes on greater importance in light of the increasing prominence of PTSD. “It is estimated that 6.8% of U.S. men and women will have PTSD at some point in their lives but that roughly 15% of returning veterans have PTSD; combat trauma is especially likely to lead to PTSD,” says Schnurr.

“Even though it is now in the news all the time, it’s important that it remain there, because it’s a prevalent and serious disorder,” she continues, adding that the current conflicts offer opportunities to not only conduct more research, but also conduct it in ways that haven’t been done before. “Much of the research done since the diagnosis was established in the 1980’s was done after the fact; researchers talked to people long after they were traumatized, so they had to rely on memories.”

The symptoms of PTSD can interfere with daily life for civilians, let alone for members of the military, Schnurr notes, explaining, “There are three types of symptoms. One is re-experiencing the trauma through unwanted memories or nightmares. Then, there’s avoidance and numbing; the patient may change behaviors to avoid people or thoughts that remind them of the trauma. Instead of reaching out for help, they shut down. Finally, they can become keyed up and aroused, angry or irritable and lose sleep.”

In addition to making it difficult to function in employment, marital or parental roles, PTSD can also lead to physical health problems. “This includes a variety of known medical conditions — especially but not exclusively cardiovascular problems,” says Schnurr. “They may also include arthritis, rheumatism and perhaps even diabetes.”

One study showed, for example, that “Across age strata, women with PTSD had more medical conditions and worse physical health status (physical functioning, role limitations due to physical problems, bodily pain, and energy/vitality scales) from the veterans than women with depression alone.” ⁵

Beyond the symptoms themselves, says Schnurr, PTSD presents a challenge because it is severe and persistent. “We do tend to recover, however, and most patients have symptoms that are gone or manageable within a month or so,” she adds.    In fact, she continues, some patients are able to function well enough to stay in their roles in the military; it is not necessarily a total disability. “Some in the military are still doing their jobs, while others are removed from duty — and then returned to duty, depending on when an individual who has been removed from duty is ready to go back — but if you get treatment, you can make a good recovery,” Schnurr explains.

Treatments are effective

Fortunately, Schnurr notes, a number of therapies have proven effective for treating PTSD. For example, her own early research helped demonstrate the efficacy of prolonged exposure, a type of cognitive behavioral therapy. “In prolonged exposure, a patient is asked to vividly recount a traumatic event repeatedly until the patient’s emotional response decreases and to gradually confront safe but fear-evoking trauma reminders,”⁶ wrote Schnurr and her colleagues.

While the study focused on female veterans (in fact, the authors said to their knowledge it was “the first randomized clinical trial to assess PTSD treatment for active duty and veteran women”), Schnurr says “I don’t think there should be any difference [in treating men and women]; there is no strong evidence they react differently to treatment for PTSD. The more important principle is to ensure that patients have the opportunity to get evidence-based treatment and that their preferences are more taken into account concerning medication and psychotherapies. The dominant factor is to give them the access and opportunity to choose what they prefer.”

The results of Schnurr’s research were in turn used in a VA program overseen by the Office of Mental Health Services that has successfully trained more than 1,400 providers in PE therapy for the treatment of PTSD, and initial results indicate the value of evidence-based practice in treatment. Initial evaluation of the program showed an overall decline of an average of about 30% (20 points) in PTSD checklist scores among those completing treatment, according to an article in the Journal of Traumatic Stress. ⁷ The paper also found provider rates of participation to be quite high; so far, 88% of training participants in the three-year-old program have either completed training or are currently participating in a training program.

References

1. Schnurr PP, Friedman MJ, Engel CC, Foa EB, et al. Cognitive Behavioral Therapy for
Posttraumatic Stress Disorder in Women: A Randomized Controlled Trial. JAMA. 2007;297:820-830.

2. Adamson, D, Burnam A, Burns RM, Caldarone LB, et al. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation, 2008. http://www.rand.org/pubs/monographs/MG720.

3. Vogt D, Vaugh R, Glickman ME, Schultz M, et. al. Gender differences in combat-related stressors and their association with post deployment mental health in a nationally representative sample of U.S. OEF/OIF veterans. Journal of Abnormal Psychology, May 30, 2011, No Pagination Specified.doi: 10.1037/a0023452

4. Maguen S, Ren L, Bosch JO, Marmar CR, and Seal KH. Gender Differences in Mental Health Diagnoses Among Iraq and Afghanistan Veterans Enrolled in Veterans Affairs Health Care. American Journal of Public Health 2010;100(12):2450-2456.  

5. Frayne SM, Seaver MR, Loveland S, and Christiansen CL. Burden of Medical Illness in Women
With Depression and Posttraumatic Stress Disorder. Arch Intern Med. 2004;164:1306-1312.

6. Schnurr PP, Friedman MJ, Engel CC, Foa EB, et al. Cognitive Behavioral Therapy for
Posttraumatic Stress Disorder in Women: A Randomized Controlled Trial.
JAMA. 2007;297:820-830.

7. Karlin BE, Ruzek JI, Chard KM, Eftekhari A, et. al. Dissemination of Evidence-Based PsychologicalTreatments for Posttraumatic Stress Disorder in the Veterans Health
Administration. Journal of Traumatic Stress, Vol. 23, No. 6, December 2010, pp. 663–673.

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