Healing Combat Trauma

The Double Whammy: Women Combat Veterans with PTSD and Military Sexual Trauma

What's blowing up right now -- on the Web -- in terms of searches, within combat trauma and PTSD: definitely this one. People, the VA included, are looking for resources on treating women combat veterans who are victims of Military Sexual Trauma (MST) (see our index to entries discussing that, linked here). 

That means one of two things (prediction coming): either there's a scandal brewing, and about to hit the news, on this topic; or, the VA and others are fairly well bereft of resources and wondering how best to treat sufferers of this problem, who are apparently reaching the VA in greater numbers.  (One possibility: news items like this that show studies recently have shown an unsurprising but nevertheless unfair disparity in care between men and women veterans.)

Unfortunately, this is another case where civilians have a better situation going for them than the troops do.  In the civilian world, women can take their employers to court for providing a sexual harrassing or otherwise hostile work environment, and their victories in this arena put other employers on notice not to go and do likewise.  Sadly, the troops have no such protection.  It's completely a double whammy: combat trauma AND trauma from rape or other sexual crime.  Women servicemembers who've been affected by it say that in their minds, predominantly, the military sexual trauma is even worse than the PTSD, though they often occur together. 

It's clear we don't have a handle yet on treating PTSD; unfortunately, PTSD concerns even more people; and MST is probably further down the list of where resources are focused right now.  But whether through growing public awareness, better reporting, or for whatever reason, if searches are any indication, the VA is in a quandary about how best to treat MST, and even who the experts / what the resources are.  We wish them, and particularly those who have been injured and mistreated in this manner, all the best, and hope the situation resolves positively, and quickly, for our women veterans, who have been doubly injured.

Homeless Veterans: Still Hidden in Plain Sight

The plight of homeless veterans may not be making the news right now as it did around Thanksgiving -- but one thing's for certain: they haven't stopped being homeless in the meantime.

Recently, Homeless Veteran Provider Technical Assistance Center listed our blog as an excellent resource -- thank you.  Note the wonderful illustration at left, done by veteran activist and artist John Paul Hornbeck, creator of the "Shattered Soldier" lifesize sculpture about PTSD, blogged about earlier, here.  John's revisions to the famous POW/MIA flag says quite kindly about the homeless veterans among us, "You Are Not Forgotten Either."  If only that were really the case -- perhaps over time we as a society can make it so.  (He's also cleverly changed "MIA" to mean, "Missing in America," pretty much the same as, "missing in plain sight" -- since clearly the homeless, and homeless veterans in particular, are everywhere, whether we choose to tune in and notice, or not.  (To see more about John Paul Hornbeck's "Shattered Soldier" sculpture, click here, here or here.) 

If you want to learn more about the plight of homeless veterans in America, start here, with the Homeless Veterans Fact Sheet, produced by the National Coalition for Homeless Veterans.  The fact sheet discusses statistics for both homeless veterans and incarcerated veterans.  And the statistics paint a grim and sorrowful picture.  According to statistics supplied by the U.S. Department of Veterans Affairs (VA), the nation's homeless veterans have been historically mostly males (though those figures are likely to change, with the advent of more women serving in the military). 

The vast majority are single, most come from poor, disadvantaged communities, 45% suffer from mental illness, and half have substance abuse problems. America’s homeless veterans have served in World War II, Korean War, Cold War, Vietnam War, Grenada, Panama, Lebanon, Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom, or the military’s anti-drug cultivation efforts in South America. Forty-seven percent of homeless veterans served during the Vietnam Era. More than 67% served our country for at least three years and 33% were stationed in a war zone. (Editor's Note: observe the connection between substance abuse and/or mental illness and homelessness. More work needs to be done to study other predisposing factors to homelessness, including PTSD and Military Sexual Trauma.)

The National Coalition for Homeless Veterans also has a good, web-based list of service providers -- programs that are geared towards homeless veterans.  Click here for that link.  They say they periodically update their website by adding more programs as information becomes available, but right now you'll only find organizations listed in the following handful of states: California, Indiana, Massachusetts, Maryland, Minnesota and New York.  (Click on any of those states' names to go right to the information available on their site.)

Women Veterans and Military Sexual Trauma

A study reported in the Journal of General Internal Medicine in 2006 compared rates of Post-Traumatic Stress Disorder (PTSD) in female veterans who had Military Sexual Trauma (MST) with rates of PTSD in women veterans with all other types of trauma.  (The full title of the article is "DSM-IV Diagnosed Posttraumatic Stress Disorder in Women Veterans With and Without Military Sexual Trauma.")

Women subjects were recruited via health appointments and/or a mailing, and completed questionairres about their military service and their health and trauma history.  The results were shocking: Ninety-two percent (92%) reported at least one (1) trauma. Forty-one percent (41%) had experienced MST, either alone or with other trauma, and 90% had other trauma, with or without MST. Overall, 43% of subjects with trauma had PTSD. And most importantly, those women veterans who had endured military sexual trauma had higher rates of PTSD.  Sixty percent (60%) of those with MST had PTSD; 43% of subjects with other traumas (with or without MST) had PTSD. Military sexual trauma and other trauma both significantly predicted PTSD in regression analyses (P = .0001 and .02, respectively) but MST predicted it more strongly. Prior trauma did not contribute to the relationship between MST and PTSD.

The study concluded, "Findings suggest that Military Sexual Trauma (MST) is common and that it is a trauma especially associated with PTSD."  To read the article itself, click here.  (The citation for the study is: J Gen Intern Med.  2006;21(S3):S65-S69.)

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(Quoting from the study):

Rape is a violent crime with long-lasting consequences that is often perpetrated against women. At particular risk are women working within male-dominated environments such as the Armed Services, which, despite a recent influx of women, continue to be composed mainly of men.

National surveys found 13% to 30% of women veterans experienced rape during their military service. What is only beginning to be understood is the long-term impact that military sexual trauma (MST), such as rape, has on the lives of women veterans.

Posttraumatic stress disorder (PTSD) is one of the known consequences of rape. In fact, rape is the trauma most highly correlated with the development of this disorder. Posttraumatic stress disorder associated with rape is long lasting. Further, PTSD itself can cause impaired physical and social functioning. Most of what is known about rape and PTSD comes from the literature on civilian sexual trauma. Much less is known about the relationship between PTSD and MST. Previous studies examining the link between PTSD and MST have identified symptoms suggestive of PTSD or have created models connecting MST with the development of PTSD.

There is only one (1) study, to our knowledge, that examined rates of DSM-IV PTSD diagnoses in women veterans with MST. Suris et al., using a sample of female Veterans Administration (VA) patients, compared rates of PTSD related to 2 types of civilian sexual trauma with PTSD rates related to MST. They found that MST was more frequently traumatizing than civilian assault. Thus, the literature indicates that MST is more predictive of PTSD than are other types of military trauma or civilian sexual trauma.

Women's Mental Health Center ("WMHC") for Women Veterans

The VA Palo Alto Health Care System (VAPAHCS), widely recognized for its innovative treatment and research pograms, introduced the Women's Mental Health Center (WMHC) in October, 2002.

The Center was created in recognition of women veterans and their right to gender-sensitive, high quality mental health care.  The Center's mission, to promote the psychological well-being of women veterans, is advanced via provision of individual and group therapy, and delivery of psychoeducational classes and seminars developed in response to the unique needs of the women we serve.  A few important links:

• The Women's Mental Health Center Home in Palo Alto, CA, linked here.
• A gallery of photos showing the campus and typical attendees, linked here.
• A brochure about the program, downloadable as a PDF, linked here.

National Women's Trauma Recovery Program ("WTRP") for Women Veterans

More than a decade ago, the Department of Veterans Affairs opened the National Women's Trauma Recovery Program (WTRP) as part of the National Center for PTSD at Menlo Park, CA. The WTRP, designed to treat women veterans with post traumatic stress disorder (PTSD), is the first residential program of its kind and is open to women across the country. Many of the women who are referred to the program were sexually assaulted during their military service and suffer what is now referred to as Military Sexual Trauma (MST). The WTRP is intensive 60-day residential program with a strong emphasis on interpersonal skills. The initial two weeks of treatment involve psychological and psychosocial assessments in order to develop comprehensive treatment plans. Women come into the program in classes, or cohorts, and work together to problem-solve, learn effective communication, and better manage their PTSD/MST symptoms.

Here's a list of key links:

• An overview of the Women's Trauma Recovery Program (WTRP), linked here.
• A statement about who's eligible to attend, linked here.
• The application itself, linked here.

The WTRP progam is headed by Darrah Westrup, Ph.D.  She has some positive, uplifting things to say about the program itself, including this quote: "our program is all about helping women reclaim their sense of worth and personal power." For more of her remarks, click here.  For more about Darrah Westrup, Ph.D., click here.

Special VA Programs Geared to Women Veterans

It's a little late for International Women's Day (March 8th) and a little early for Mother's Day (May 11th), but it's time to talk about the special needs and concerns of women warriors, and how they're affected by combat trauma.  The most recent issue of the Disabled American Veterans' magazine has an article on women combat veterans.  The public service poster graphic in particular (see left) is impressive, as is its slogan: "War is Hell: Being a [Woman] Veteran Shouldn't Be."  Click on this link to download the March/April issue as a PDF; the article begins on page 19.

It's good news that the VA is becoming more attuned to the special needs of traumatized women veterans, either through PTSD or sexual trauma, or both.  Here's a section of the main VA website that addresses VA Programs for Women Veterans.  Click here for that link.  The programs cover several important areas, including mental health and sexual abuse counseling; medical services for women veterans; education and training; research; compensation for women veterans; national cemetery administration; and demographic trends.  According to the VA's own website, women veterans should be able to get help by contacting the nearest VA center, and asking to speak to the women's program manager, who will be able to refer them to the right help.  To review the briefly-noted information on the VA website, click here.

There's also a physical facility at the VA Palo Alto Health Care System devoted to women's recovery from trauma, both combat trauma and military sexual trauma (MST).  That program is known as Women's Trauma Recovery Program, or WTRP, and it's housed in a facility, called the Women's Mental Health Center Home.  This program is open to women from all wars, with programs being developed to focus on OEF/OIF veterans.  For more from the VA about women veterans with MST, click here.

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Statistically speaking, according to the VA:

The estimated population of women veterans as of 2001 was 1.6 million, or about 7.2 percent of the total veteran population.  10.26% of the 22.8 million veterans who use VA for healthcare are women.  Currently, women make up 14.8 percent of the active duty military force and approximately 22.8 percent of the reserve force.  By 2010, they are expected to represent over 14 percent of the total veteran population.  Fifty-six percent of women veterans who use VA are less than 45 years of age.  Sixty-two percent of women veterans are less than 45 years of age.

When it comes to women veterans and Military Sexual Trauma, though, the figures are worse.  We've done a blog post about that separately.  To read that, click here.

Making a Fractured Heart Whole Again - Military Sexual Abuse and Women

The Buffalo News has an excellent feature story in today's paper about a residential program at the VA for women who are survivors of military sexual abuse, among other forms of trauma.  The residential program profiled in Batavia, NY is one of four such programs the VA runs in the country.  Others will be profiled in future blog posts.  The article is entitled, "Female Veterans Find Help with Emotional Wounds at Batavia Facility."  Go here and read the story.  For a somewhat generic link to the VA's position on women veterans with military sexual trauma (MST), click here.  For a link to the actual VA residential program for women veterans in Batavia, NY, mentioned above, click here.

On the West Coast, there is the Women’s Trauma Recovery Program (WTRP), opened by the Palo Alto, CA VA in 1992 as part of the National Center for PTSD. It is an intensive 60-day residential program with and emphasis on interpersonal skills and a focus on war-zone related stress as well as MST (Military Sexual Trauma).  For a link to a blog post discussing that in greater depth, click here.

There's also a residential program for women at the VA in Tyler, Texas.  And apparently there is a fourth program as well, but an hour plus surfing the VA's inscrutable website doesn't clarify where that is.  When I find out, I'll include the information.  For a link to the Central Texas program, click here.