Women Are the Invisible Victims of PTSD

Rose Eveleth

Research shows that women are up to twice as likely to develop PTSD, but research, treatments and laws are all designed with the combat veteran in mind.

There are lots of conversations about the lack of diversity in science and tech these days. But along with them, people constantly ask, "So what? Why does it matter?" There are lots of ways to answer that question, but perhaps the easiest way is this: because a homogenous team produces homogenous products for a very heterogeneous world.

This column will explore the products, research programs, and conclusions that are made not because any designer or scientist or engineer sets out to discriminate, but because the "normal" user always looks exactly the same. The result is products and research that are biased by design.

In 1985, Michael R. Trimple wrote in the book Trauma And Its Wake, "To this British observer, the term 'post-traumatic stress disorder' springs from the pages of the DSM-III like some newly found tropical flower, previously undescribed, yet clearly present in its full-blooded maturity for any onlooker to see."

Just five years before, PTSD had been added to the DSM, psychology's standard diagnostic manual, amidst much controversy. But in the 31 years since, Trimple's description of PTSD as a condition that has always been around, flowering silently, has been largely accepted. Of course, PTSD existed long before doctors gave it a name and a diagnostic code. Some researchers point to Shakespeare's "King Henry IV," wondering if the bard's character was showing symptoms of the disorder. Samuel Pepy's Diary, in which he recounts the Great Fire of London, has been similarly analyzed as a text that describes PTSD.

But naming a disorder does help it become more accepted. Today, the premise that a combat veteran might return with PTSD a well publicized idea. But the idea that a woman who has experienced abuse and trauma might experience the disorder is still called into question.

Women with PTSD often don't show the same set of behaviors as men with PTSD, so they're often misdiagnosed

Movies like The Hurt Locker and Jacob's Ladder have portrayed PTSD in military men, but a woman named Melody Hensley who was diagnosed with PTSD from cyberstalking was met with a storm of skepticism and additional harassment from folks who assume she is lying. "Smellody smellody your PTSD is imaginary. War vets have gone through worse, you are just a insensitive jerk," tweeted one person, which is relatively emblematic of the general response: If you're not a veteran, you haven't seen combat or "true" trauma, you can't get PTSD.

In the public's eye, military men are still the sole sufferers of PTSD. But research shows that women are in some cases twice as likely to develop the disorder. Despite being far more vulnerable, women are women are often misdiagnosed due to cultural stereotypes, and there's a huge gap in research on which kinds of treatments work best for which kinds of people. Studies and research programs have been designed, until recently, to understand men with PTSD. The same is true for support systems and treatment centers. In the legal system, women who report PTSD from rape are less likely to be believed than men who report PTSD from combat.

Research shows that women are at a higher risk of PTSD. While men experience more traumatic events in their lives, women are, depending on which study you look at, as much as twice as likely to develop PTSD, but no one really knows why. The researchers I talked to have some idea though: While the popular perception is that the "Trauma" in "Post Traumatic Stress Disorder" has to be something like explosions and war, you can actually get PTSD from any kind of shock and terror. Women are more likely to be the victims of sustained abuse, as opposed to one-time attacks. And they're more likely to experience domestic trauma at the hands of a partner or loved one.

That domestic bit has another face too: Where men who've experienced trauma might be able to take time off to recover, women are expected to maintain their domestic, caregiving roles, which makes it harder for women to address symptoms of post-traumatic stress for fear of "failing" at their roles as mother, daughter and wife.

"Gendered social roles can compound the negative impact," said Dawne Vogt, a research psychologist at the Women's Health Sciences Division of the National Center for PTSD. "So they might have additional stress when they're dealing with something."

Media portrayals of PTSD also compound the problem. For example, searching Getty's stock image service, which is normally pretty nuanced as far as stock images go, for "woman PTSD" produces first an image of a man and then a series of women in fatigues. Image: Getty

Technically, PTSD is largely the same for men and women, characterized by things like fear based anxiety, sleep disturbance, flashbacks, feelings of detachment and more. And both men and women often experience multiple conditions alongside PTSD. But they seem to develop different sets of additional problems. Women tend to develop depression alongside their PTSD, while men tend to tack on substance abuse. What that means is that men with PTSD tend to show a different profile than women do. Men tend to lash out, showing anger, hostility, explosiveness and unpredictability. Women, often because of their depression, tend to do the opposite, becoming withdrawn and turning to self harm.

And these differences, along with the media portrayal of PTSD, impacts how women are treated, said Susan Berg, a clinical social worker at The Women's Mental Health Consortium in New York who specializes in PTSD and women. According to Berg, because women with PTSD often don't show the same set of behaviors as men with PTSD, they're often misdiagnosed with things like borderline personality disorder or postpartum depression.

"I think it's very common," she told me. "There's the stereotype of the depressed housewife and the postpartum woman. We tend to categorize women of old stereotypes of what they have, instead of really looking at a wide arrange of symptoms that give us a clue that there is trauma."

(Berg also points out that this isn't just the case for women. There's a growing body of research that suggests that experiencing ongoing racism can make people more vulnerable to PTSD.)

Vogt is specifically tasked with studying women in her work within the Veteran's Administration. But she says that can still be hard to do. Women currently make up only 15-20 percent of the military overall, and a smaller set of them work in combat roles. So when her research team puts out a call for former service members for a study on PTSD, they're going to invariably get more men than women.

"The only way to really get a better understanding is to either draw a really big sample, or to over-sample women," Vogt said, adding that they usually opt for the latter, specifically seeking out women for their studies, but it makes the work harder.

Virtual reality offers interesting promise for treating PTSD, but research is largely focused around working with military men.

And, to make things more confusing, Vogt's work has shown that, unlike in the outside world, women and men in the military are equally likely to develop PTSD. So even if studies include female veterans, they might not be able to explain or provide insight to non-military women's experiences with PTSD. And, again, nobody knows why these women seem to be less vulnerable than those outside the military.

What is clear is that women who return from combat, with PTSD or not, often have a harder time returning to their lives. According to a report by the Departments of Veterans Affairs, Defense, Labor and Housing and Urban Development, "America's nearly 300,000 women veterans are put at risk by a system designed for and dominated by male veterans." This includes lack of access to peer support, group therapy and specialized mental health care for things like PTSD.

Women veterans are also more likely to be unemployed than male veterans, and at least twice as likely to be homeless. On top of that, women veterans are more likely to be single parents and come back to dependents. But Vogt says that nobody knows how this might impact their PTSD, or which treatments might work best. And it's not necessarily clear that what works for veterans will work for civilians either. Right now, for example, most of the research on virtual reality uses for treating PTSD focuses on military men.

Figuring out which treatment works best for PTSD is still an ongoing process for everybody, men and women alike. But if researchers want to help treat people equally, they'll need to include more women, and non-military folks in their studies. Because PTSD impacts everybody, not just the battle hardened soldier.