According to the U.S. Department of Veterans Affairs’ National Center for PTSD, about six in 10 men and five in 10 women experience at least one trauma during their lifetimes. While women have a smaller statistical risk of being exposed to trauma, they are more than twice as likely as men to develop post-traumatic stress disorder (PTSD).1 That means that of the nearly 8 million adults who suffer from PTSD during a given year, there are statistically more women than men combatting the symptoms.
PTSD in the Military
Women comprise about 15% of active-duty soldiers and 20% of the National Guard and U.S. Army Reserves. They are the fastest growing group of U.S. veterans and experience PTSD at about the same rate as men. An estimated 20% of women who served in Iraq and Afghanistan have been diagnosed with PTSD.2 Although some PTSD cases in women are attributed to combat-related stress, military sexual trauma (MST) is responsible for a very large number of the PTSD cases in women. While the Veteran’s Administration treats only a small percentage of female veterans, its findings are indicative of a serious problem. A screening the VA conducted on its patients revealed that more than 24% of female veterans suffered from MST. This group was found to be three times more likely to suffer from mental health issues including PTSD. That compared to an MST incidence rate of just 1.3% in their male counterparts.3
PTSD Risk Factors
People of any age and gender can develop PTSD, although there are specific risk factors that make a person more prone to it, such as:
- Surviving a natural disaster, physical assault or rape, or major accident
- Combat participation or combat exposure
- Surviving or witnessing a terror attack
- Childhood history of sexual or physical abuse
- The sudden, unexpected death of a loved one
The Gender Equation in PTSD
Compared to their male counterparts, women exposed to highly dangerous or life-threatening circumstances have a sharply elevated risk of developing PTSD symptoms. Nearly 10% of women versus 4% of men develop PTSD.1 The possible factors that cause a higher prevalence of PTSD in women include:
- Being more likely to experience rape and other forms of sexual assault
- A stronger tendency to blame themselves for a traumatic event, a key factor that leads to damaging stress
- A history of mental health issues such as depression or anxiety
- Lack of access to a well-developed social support network
PTSD Symptoms in Women
Symptoms usually begin within three months of the traumatic incident, although they may take years to emerge. In order to be diagnosed with PTSD, a person must exhibit symptoms that last more than a month. While men and women can both experience the cardinal symptoms of PTSD (hyperarousal, re-experiencing, avoidance and numbing), some behaviors are more prevalent4 in women than men, including:
- Feeling jumpy
- Trouble feeling emotions
- Avoiding trauma reminders
The Menstrual Cycle
The menstrual cycle is the term commonly used to describe the monthly changes in a woman’s reproductive system that begin with egg production and end with the shedding of the blood-thickened lining inside the uterus (unless sperm fertilizes an egg). Specific stages of the menstrual cycle include the follicular phase (marked by the development of an egg inside the ovaries) and the luteal phase (the beginning of which is marked by ovulation, or the release of an egg from the ovaries).
Impact of the Menstrual Cycle on PTSD Severity
A study published in the Journal of Traumatic Stress presented findings of a small-scale project involving 49 women to assess whether the menstrual cycle had any effect on the severity of PTSD symptoms. All of the participating women were previously exposed to highly traumatic events capable of triggering PTSD. Some of the women had developed the disorder, while others had not. In both groups, the researchers looked at the severity of any trauma-related reactions during the follicular phase and luteal phase of monthly menstruation.
After analyzing the data, the researchers concluded that women’s reactions to trauma were significantly worse during the follicular phase of menstruation. This finding applied to psychological symptoms in general, as well as symptoms of phobia-related anxiety and depression. The researchers also concluded that compared to trauma-exposed women who did not develop PTSD, trauma-exposed women with the disorder experienced substantially heightened symptoms of phobia-related anxiety during the follicular phase of menstruation. Among the study participants, the presence of PTSD during this phase of menstruation increased the impact of phobia-related anxiety by about 63%.
The study’s authors noted that women unaffected by PTSD typically had no change in phobia-related anxiety levels during any phase of the menstrual cycle. This implies that phobic reactions in women with PTSD may largely account for the spike in anxiety observed during menstruation’s follicular phase. The researchers concluded that fear-/phobia-related reactions of women with PTSD rise sharply during the first days of the menstrual cycle.5
A combination of traditional and complementary therapeutic approaches are utilized to treat people with emotional trauma/PTSD. Some people recover within six months, while others continue to have symptoms for much longer. Treatment includes:
- Cognitive Behavioral Therapy (CBT)
- Eye movement desensitization and reprocessing (EMDR)
- Stress inoculation training
- Somatic experiencing
- Craniosacral therapy
The most common trauma for females is sexual assault or sexual abuse during childhood, with one in three women experiencing a sexual assault in her lifetime. Women are more likely to be neglected or abused in childhood, be the victims of domestic violence, or have a loved one suddenly die. These factors coupled with a growing number of female military personnel have caused an increase in the number of women with PTSD symptoms. Furthermore, the research connecting the severity of PTSD symptoms to phases of the menstrual cycle provides further evidence of gender differences. This provides compelling evidence that PTSD treatment approaches need to address inherent gender differences with individualized solutions.
- How Common Is PTSD? U.S. Department of Veteran Affairs National Center for PTSD website. http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp Updated Aug. 13, 2015. Accessed June 10, 2016.
- A few good women: RNs are learning to better care for U.S. female veterans with PTSD. Nurse.com website. https://news.nurse.com/2015/02/09/a-few-good-women-u-s-female-veterans-with-ptsd-are-getting-better-care/ Published Feb. 9, 2015. Accessed June 10, 2016.
- Focusing on a Solution for PTSD in Women Veterans. National Veteran Foundation website. http://nvf.org/ptsd-in-women-veterans/ Published Aug. 27, 2015. Accessed June 10, 2016.
- Women, Trauma, and PTSD. U.S. Department of Veteran Affairs National Center for PTSD website. http://www.ptsd.va.gov/public/PTSD-overview/women/women-trauma-and-ptsd.asp Updated Aug.13, 2015. Accessed June 10, 2016.
- Nillni Y, Pineles SL, Patton SC, Rouse MH, Sawyer AT, Rasmusson AM. Menstrual cycle effects on psychological symptoms in women with PTSD. J Trauma Stress. 2015 Feb;28(1):1-7. doi: 10.1002/jts.21984. Epub 2015 Jan 22.