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Women at war: Mental health toll unknown

By Amy Cox
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Editor's note: This story was originally published in May 2006.

(CNN) -- More American women are closer to combat in Iraq than in any other modern war, and there are many unknowns about the mental health effects they may experience when they come home from the war zone.

"In the civilian world, post-traumatic stress disorder has traditionally been much more common in women than in men," says Col. Elspeth Cameron Ritchie, the psychiatry consultant to the U.S. Army surgeon general.

"This is the first time that we've really had a large number of women that are over in a combat zone so we are studying how they do, but the results aren't out yet." (Gallery: Women in the military)

Shell shock, war neurosis, battle fatigue. Post-traumatic stress disorder, or PTSD, has gone by many names in a century's worth of wars. First recognized as an official diagnosis five years after the Vietnam War, the psychiatric disorder can strike a person after life-threatening events -- such as wars or natural disasters -- with symptoms such as flashbacks, detachment or depression, according to the National Institute of Mental Health.

"What we're seeing now, very commonly, is similar to PTSD after Vietnam, but it has its own pattern -- we're seeing a lot of nightmares, we're seeing people who have hyper-vigilance and then some difficulty fitting back in," Ritchie says. "And I think it will actually be awhile before we really have the full picture."

But how post-traumatic stress disorder affects women who served in war zones is still at the early stages of research. One of the few studies done involved female Vietnam veterans in 1983 and found more than a quarter suffered from the disorder sometime during their postwar lives, according to the National Center for PTSD. In the general population, women suffer from the disorder at twice the rate as men.

Today, the Department of Veterans Affairs reports that about a third of the servicemen and women from Iraq who sought health care were seeking help for mental health issues. The proportion of women is not known, according to spokesman Jim Benson.

One survey released by the Army in 2005, however, found that the rates of mental health problems among returning male and female soldiers from Iraq were similar -- 13 percent and 12 percent, respectively.

Ritchie explains that any difference in the rates between men and women may be due to the fact that women are less exposed to firefights in most cases than men.

"I emphasize a little bit less because in most cases, they are in the combat zone, but to a large extent they're not out doing the patrols with infantry," she says. "It's a lower rate, but I don't want to predict that it will stay at a lower rate."

These findings mean even more research and funding needs to go to examining the mental health of women -- who make up 15 percent of the active duty force and almost a quarter of the reserves -- according to Steve Robinson, executive director of the National Gulf War Resource Center, a nonprofit veterans advocacy organization.

"The VA currently does not have any specialized care program for female combat veterans," Robinson says. "And our VA health care system is based on males who go to war. ... It's different now.

"Men and women are different. We handle things differently; we perceive things differently," he continues. "I'm not saying women can't cut it because they can. Some of the best Special Operations warriors we have are females ... but there's a difference."

Ritchie also sees some differences in women adjusting to home life again after Iraq, especially those with children.

"Based on anecdotal evidence, not formal data, women who are mothers, especially with younger children ... tend to feel guilty being away from their children," she says. "This is where we really don't have a whole lot of data yet on re-integration."

Finding help

On returning home, all troops are required to fill out a health assessment and then another survey three to six months afterward. New mental health treatment programs and options have been added to military services over the course of the Iraq war, according to Ritchie.

Some, like Robinson, believe these steps are not enough, but Ritchie says the military is doing more than it ever has before to screen and treat servicemen and women.

As one of the latest steps in uncovering some of the mysteries of women and post-traumatic stress disorder, the VA launched a study last year looking at the disorder in women veterans from all eras and the types of treatment that are most effective for women specifically. The results are under review by researchers, possibly to be released later this year.

Like men, women usually get counseling and certain medications for the disorder. Robinson says such treatment is one area that the differences in the sexes become apparent.

"For example, if you co-mingle women and men in group therapy sessions, there are things those men and women will not talk about in front of other males or females," he says.

"I met a girl who had lost her leg in Iraq, and she was concerned about whether or not she was going to be able to hold her baby because every time she picked up her child, it reminded her of a baby she saw who got hurt in Iraq. That's not something she's going to talk about in front of a whole bunch of guys."

For now, Ritchie says the military doesn't see the need for a specialized treatment program, but it's "certainly possible that will evolve as time goes on."

In the future, she says she'd like the military to make sure women are a big part of any studies on post-traumatic stress disorder and other topics, especially the effect on family members.

But most inside and outside the military agree that it's imperative that women veterans, as well as their male counterparts, get the attention and treatment they need right now.

"Invest now to make sure they don't have problems," Robinson says. "Then we won't repeat the legacy of Vietnam where we just told people to get over it, and we've had 40-plus years of social welfare taking care of those people we didn't help when they came back."

Post-traumatic stress disorder in women at war is still in the early stages of research.


• Audio slide show: War families
• Gallery: Welcome back
• I-Reports: Salute to troops



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