IRAQ WAR CLINICIAN GUIDE

Iraq War Clinician Guide 179 Appendix I
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POST-TRAUMAnCSTRESDISOtlDER IN TllE MILITARY VFlEllAN 269
wneexposure are four times more likely than their less exposed counterparts to
have current FTSD.n
Inaddition ton~~ro~r,~l of war-zone exposure, lypc 01 exposure is an important
risk factor for PTSD. Being wounded or injured increases the risk of current
PTSD twofold to threefold in boll1 male and female veterans." Exposure to
atrocities also increases the risk of PTSD, even when amount of other .war-zone
experiences is taken intoaccount!" An especially traumalicevent in the war zone
is being imprisoned by the enemy. One study of World War 11 veterans wlio had
been prisoners of war in the Pacific theater found that 78% had lifetime FED
and 70"' had current MSD; in contrast, World War I1 veterans with high warzone
exposure were much less likely to have lifetime (29%) or current (IS"/.)
mD."
Poslmililary Factors
An important predictor of PTSD is the nalun? af the post-traumatic environmelit.
In axale Viehram veterans, poor social support botll a1 homecoming and at
prescnt is associated with increased risk of PI'SD.'" Anotltcr significant postmilitary
factor is a veteran's copingskills," although coping deficits may be relatively
specific to war-related slrussors (i.e., memories) and not to cvcryday streswrs."
SPECIAL POPULATIONS
Most research on FTSD in war veterans has beerr conducted in Western
industrialized naliotl~ (United States, Europe, Ismel, and Aostri~lia). Witlr few
exceptions."lZi most studies have focused on i\.hite male veterans. Far less research
has addressedthe matter of I'EU among female, ethnic minority, or
physically disabled veterans. The only studies on the impact of war-zone slress
on people from non-Western or traditional etlmwultural backgrounds have focused
on civilian or refugee cohorts exposed lo mililary violencLJs and therefore
are outside the scope of this article.
The nrost extensive research on FTSD in fenrale military ycrsonnel has focused
on female Viemani theater vetelans. Most of these women were nurses,
although some sci~,cd in intelligence, secilrily. supply. clerical, and air traffic
control positions. Althougl~ they did not function as combatants, many female
Vietnam theater veterans had high levels of exposure to war-zone trauma, especially
nurses, who were often expo& to a constant stream of combat casualtics
12 hours a day, 6 days a week for 12months. The NVVRS showed that patterns
of PTSD association with risk factors were generally similar for male and female
Vietnam vel~rens.~'The women,on average, howe\,er, differed from men in that
they tended to be rvhite, older, better educated, and more likely to have the rank
of officer. In addition, some female wlerans also experienced sexual harassment
and assault.'* 'rite adverse, traumatic impact of sexual assault on the mililary
experience of womm has only begun lo receive the aNe11lioir it deserves. It
certainly appears to contribute substantially to the de~~elop~nent of PTSD among
fernale n~ilitary persolurcl.
Turning to data on velerans of the Persian Ctdf War, cited earlier, women
reported more PrSD symptoms than nrca at 5 days and 18 months aftcr their
return to the United States. It is i~nclrar whether the higher prevalence among
female veterans reflects sexual tmuma in addition lo other rvar-zone stressors or
it rellccls n greatcr tendency for women to e~rdorse PTSD syinptomsonquestior!-
naires.
DEPARTMEhT OF VETERAhS AFFAIRS
.... -.u~..---..L-..-m"
NATIONAL CENTER FOR PTSD