By Cmdr. Jean Fisak, NC, deputy director, Naval Center for Combat & Operational Stress Control
In the past decade, more active duty females than ever before have experienced combat and operational stress.
In modern warfare, the lines between combatants and non-combatants have blurred. Traditional frontlines have all but disappeared in the face of urban warfare. Everyone in a warzone is vulnerable to enemy attack. And everyone is at risk of being injured.
A large number of the injuries we’ve seen as a result of the conflicts in Iraq and Afghanistan are psychological. Invisible wounds like post-traumatic stress disorder (PTSD). Wartime experiences –being in a convoy that is attacked and seeing a fellow Marine injured or killed or working in a fl eet surgical hospital putting a Sailor back together after he’s stepped on an IED – can inflict psychological trauma and lead to PTSD.
PTSD is an equal opportunity injury, affecting men and women alike. We have seen rising numbers of female service members diagnosed with PTSD in recent years. And, we will probably see more as the barriers that once prevented women from serving in direct combat dissolve and exposure to combat stress and trauma increase.
But there is good news. Exposure to trauma does not mean that someone will develop PTSD. Whether or not PTSD develops is dependent on several elements including inherent risk factors and individual resilience. Some of these factors are things that can be controlled – by leaders, by health care providers and by individuals – by reducing the environmental stressors we have control over and providing opportunities to build resilience. To do this, we need to have an understanding of how PTSD affects women and what specific things we can control.
Risk Factors for PTSD in Active Duty Females
There are several risk factors that can contribute to the development of PTSD in women. Being aware of which risk factors affect the females in our units allows us to give them the support they need to manage additional stressors. Risk factors associated with PTSD, include:
- History of traumatic events
- Military sexual trauma (MST)
- Low social support
- Family separation
In general, women are more likely than men to have a history of traumatic events such as childhood sexual abuse or domestic violence, which may cause more emotional suffering than other types of trauma. This may increase their vulnerability to developing post-traumatic stress disorder (PTSD). If an individual has old psychological traumas that have not been treated, this may decrease their level of resilience and ability to cope with new traumas or stressors.
We also know that women have a higher risk for sexual trauma in the military, particularly during deployments. Unfortunately, despite ongoing efforts to prevent sexual assault, approximately 12 percent of females who have deployed report MST compared to men who report less than one percent, on average. Female service members with a history of MST are more likely to be diagnosed with PTSD and depressive disorders than females without a history of MST.
As the minority gender in the military, women may experience lower levels of actual or perceived social support; something we know is a protective factor against developing stress illnesses and injuries. The social support that typically comes from unit cohesion is based on shared experiences, which means those of the same gender are more likely to share similar experiences that can lead to social bonding. Additionally, if a female service member is sexually assaulted by a member of her unit, isolation may ensue, further removing her from any unit-level social support.
Often, the primary forms of social support for female service members come from those outside of their unit, in particular their family. While having a supportive family is a good thing, the separation from them during deployment can be a major source of stress. This can be especially true for women, who are more likely to be single parents than their active duty male counterparts. Disruptions to family life have been more strongly associated with post-deployment PTSD in active duty women than in men.
Mitigating Risk Factors for PTSD in Active Duty Females
Risk factors are an important way to gauge who may be vulnerable to developing PTSD, but they aren’t written in stone. Simply because a service member has some, or even all, of them does not mean they will end up with a mental health condition. We are all unique individuals who not only respond differently to stress, but also come equipped with different levels of resilience. Mitigating risk factors for PTSD is something that can be done by leaders by minimizing environmental stressors and increasing protective factors, and by individuals who work to strengthen their personal resilience.
Ways leaders can mitigate risk factors for PTSD:
- Create opportunities for realistic training that equips female service members to prepare for deployment and combat operations. Simulating these types of experiences and allowing personnel to become familiar with equipment creates a level of comfort and reduces stress.
- Create command climates that promote dignity, mutual respect and empathy in efforts to eliminate sexual assault.
- Know your troops. Taking an interest in individual service members and their histories, enables leaders to potentially identify those at risk for developing PTSD due to prior traumatic experiences.
- Support unit cohesion. Providing opportunities and activities for shared experiences that are inclusive of females within the unit enables everyone to be part of a supportive social network. Unit cohesion is a known protective factor against PTSD.
Ways individuals can mitigate risk factors for PTSD:
- Build resilience. Resilience is not a fixed state and it can be strengthened and maintained by developing positive coping skills, optimism, behavior control and flexible thinking. Simple things like exercise, building friendships and making time to do enjoyable activities can all increase individual resilience.
- Address personal histories of trauma. If an individual has a history of trauma in their past that has not been treated, seeking out mental health care prior may prevent a stress injury or illness due to deployment or combat operations.
Understanding what risk factors are unique to our female service members and finding ways to mitigate them improves their mental health outcomes and preserves readiness. As both the number of women on active duty and their roles in within the military continue to grow, optimizing their psychological health not only enhances individual and unit-level performance; it ensures that our diverse Navy and Marine Corps team is ready to meet any challenge.